ABSTRACT
Free vascularized fibular transfer for avascular necrosis of the femoral head was
developed in an attempt to preserve, rather than replace, the femoral head. In this
procedure, the peroneal vessels of the autogenous fibular graft are anastomosed to
recipient branches of the lateral femoral circumflex vessels. A problem with this
procedure has been the difficulty in locating the lateral femoral circumflex vessels.
An anatomic and surgical study was conducted to seek a consistent anatomic landmark
for use in isolating these vessels.
Ten cadaveric and 29 surgical hip dissections were performed. A falx, or fascial band,
was consistently found approximately 10 cm distal to the anterior superior iliac spine;
it is attached to the anterior intertrochanteric line of the proximal femur, with
additional attachments to the investing fascia of the tensor fascia lata and rectus
femoris muscles. Cautious release of this falx from superficial to deep leads to the
fat layer surrounding the lateral femoral circumflex vessels.
This study has shown that an anatomic landmark exists, which consistently leads to
location of the lateral femoral circumflex vessels during a free vascularized fibular
transfer. By incorporating the use of this landmark into the authors' surgical technique,
they have significantly reduced surgical dissection time and have provided a safe
method for isolating the recipient vessels during this challenging operation.
