Descending Geniculate Artery: The Ideal Recipient Vessel for Free Tissue Transfer Coverage of Below-the-Knee Amputation Wounds

ABSTRACT

The descending geniculate artery has received notoriety as the source vessel of the medial femoral condyle vascularized bone flap in recent years. Its size and location enable it to serve as a useful recipient vessel in free flap reconstruction about the knee. It is particularly useful in coverage of unstable below-the-knee amputation stumps when recipient vessels are limited. It provides the ease and convenience of two-team surgery in the supine position and its distal position permits convenient and distal insetting of the transferred flap of choice. A discussion of its use in this setting and exemplary cases are provided.

KEYWORDS

Below-the-knee amputation - descending geniculate artery - recipient vessel for free flap transfer - medial femoral condyle

REFERENCES

• 1 Tukiainen E J, Saray A, Kuokkanen H O, Asko-Seljavaara S L. Salvage of major amputation stumps of the lower extremity with latissimus dorsi free flaps.  Scand J Plast Reconstr Surg Hand Surg. 2002;  36 (2) 85-90
• 2 Gallico III G G, Ehrlichman R J, Jupiter J, May Jr J W. Free flaps to preserve below-knee amputation stumps: long-term evaluation.  Plast Reconstr Surg. 1987;  79 (6) 871-878
• 3 Erdmann D, Sundin B M, Yasui K, Wong M S, Levin L S. Microsurgical free flap transfer to amputation sites: indications and results.  Ann Plast Surg. 2002;  48 (2) 167-172
• 4 Yildirim S, Calikapan G T, Akoz T. Reliable option for reconstruction of amputation stumps: the free anterolateral thigh flap.  Microsurgery. 2006;  26 (5) 386-390
• 5 Johnson P E, Harris G D, Nagle D J, Lewis V L. The sural artery and vein as recipient vessels in free flap reconstruction about the knee.  J Reconstr Microsurg. 1987;  3 (3) 233-241
• 6 Weinberg H, Kenan S, Lewis M M, Hausman M R, Vickery C B, Bloom N D. The role of microvascular surgery in limb-sparing procedures for malignant tumors of the knee.  Plast Reconstr Surg. 1993;  92 (4) 692-698
• 7 Yuen J C, Zhou A T. Free flap coverage for knee salvage.  Ann Plast Surg. 1996;  37 (2) 158-166
• 8 Hong J P, Koshima I. Using perforators as recipient vessels (supermicrosurgery) for free flap reconstruction of the knee region.  Ann Plast Surg. 2010;  64 (3) 291-293
• 9 Park S, Eom J S. Selection of the recipient vessel in the free flap around the knee: the superior medial genicular vessels and the descending genicular vessels.  Plast Reconstr Surg. 2001;  107 (5) 1177-1182
• 10 Doi K, Sakai K. Vascularized periosteal bone graft from the supracondylar region of the femur.  Microsurgery. 1994;  15 (5) 305-315
• 11 Lapierre F, Masquelet A, Aesch B, Romana C, Goga D. [Cranioplasties using free femoral osteo-periostal flaps].  Chirurgie. 1991;  117 (4) 293-296 discussion 297
• 12 Martin D, Bitonti-Grillo C, De Biscop J et al. Mandibular reconstruction using a free vascularised osteocutaneous flap from the internal condyle of the femur.  Br J Plast Surg. 1991;  44 (6) 397-402
• 13 Sakai K, Doi K, Kawai S. Free vascularized thin corticoperiosteal graft.  Plast Reconstr Surg. 1991;  87 (2) 290-298
• 14 Bakri K, Shin A Y, Moran S L. The vascularized medial femoral corticoperiosteal flap for reconstruction of bony defects within the upper and lower extremities.  Semin Plast Surg. 2008;  22 (3) 228-233
• 15 Choudry U H, Bakri K, Moran S L, Karacor Z, Shin A Y. The vascularized medial femoral condyle periosteal bone flap for the treatment of recalcitrant bony nonunions.  Ann Plast Surg. 2008;  60 (2) 174-180
• 16 Del Piñal F, García-Bernal F J, Regalado J, Ayala H, Cagigal L, Studer A. Vascularised corticoperiosteal grafts from the medial femoral condyle for difficult non-unions of the upper limb.  J Hand Surg Eur Vol. 2007;  32 (2) 135-142
• 17 Fuchs B, Steinmann S P, Bishop A T. Free vascularized corticoperiosteal bone graft for the treatment of persistent nonunion of the clavicle.  J Shoulder Elbow Surg. 2005;  14 (3) 264-268
• 18 Jones Jr D B, Moran S L, Bishop A T, Shin A Y. Free-vascularized medial femoral condyle bone transfer in the treatment of scaphoid nonunions.  Plast Reconstr Surg. 2010;  125 (4) 1176-1184
• 19 Pelzer M, Reichenberger M, Germann G. Osteo-periosteal-cutaneous flaps of the medial femoral condyle: a valuable modification for selected clinical situations.  J Reconstr Microsurg. 2010;  26 (5) 291-294
• 20 Yamamoto H, Jones Jr D B, Moran S L, Bishop A T, Shin A Y. The arterial anatomy of the medial femoral condyle and its clinical implications.  J Hand Surg Eur Vol. 2010;  35 (7) 569-574
• 21 Kobayashi S, Kakibuchi M, Masuda T, Ohmori K. Use of vascularized corticoperiosteal flap from the femur for reconstruction of the orbit.  Ann Plast Surg. 1994;  33 (4) 351-357 discussion 357-358
• 22 Henry M. Genicular corticoperiosteal flap salvage of resistant atrophic non-union of the distal radius metaphysis.  Hand Surg. 2007;  12 (3) 211-215
• 23 Gaggl A J, Bürger H K, Chiari F M. Free microvascular transfer of segmental corticocancellous femur for reconstruction of the alveolar ridge.  Br J Oral Maxillofac Surg. 2008;  46 (3) 211-217
• 24 Kaminski A, Bürger H, Müller E J. Free vascularised corticoperiosteal bone flaps in the treatment of non-union of long bones: an ignored opportunity?.  Acta Orthop Belg. 2008;  74 (2) 235-239
• 25 Gaggl A, Bürger H, Chiari F M. The microvascular osteocutaneous femur transplant for covering combined alveolar ridge and floor of the mouth defects: preliminary report.  J Reconstr Microsurg. 2008;  24 (3) 169-175
• 26 Cavadas P C, Landín L. Treatment of recalcitrant distal tibial nonunion using the descending genicular corticoperiosteal free flap.  J Trauma. 2008;  64 (1) 144-150
• 27 Sammer D M, Bishop A T, Shin A Y. Vascularized medial femoral condyle graft for thumb metacarpal reconstruction: case report.  J Hand Surg Am. 2009;  34 (4) 715-718
• 28 Larson A N, Bishop A T, Shin A Y. Free medial femoral condyle bone grafting for scaphoid nonunions with humpback deformity and proximal pole avascular necrosis.  Tech Hand Up Extrem Surg. 2007;  11 (4) 246-258
• 29 Jones Jr D B, Bürger H, Bishop A T, Shin A Y. Treatment of scaphoid waist nonunions with an avascular proximal pole and carpal collapse. A comparison of two vascularized bone grafts.  J Bone Joint Surg Am. 2008;  90 (12) 2616-2625
• 30 Jones Jr D B, Bürger H, Bishop A T, Shin A Y. Treatment of scaphoid waist nonunions with an avascular proximal pole and carpal collapse. Surgical technique.  J Bone Joint Surg Am. 2009;  91 (Suppl 2) 169-183