Anatomic and high resolution computed tomographic angiography study of the lateral femoral condyle flap: implications for surgical dissection

Publication date: Available online 16 August 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Mohamed Morsy, Yoo Joon Sur, Osman Akdag, Amr Eisa, Tarek A. El-Gammal, Nirusha Lachman, Steven L. Moran
BackgroundThe Lateral femoral condyle (LFC) flap is a vascularized bone flap based on the superior lateral genicular artery (SLGA). Harvest technique for this flap has not yet been demonstrated. The purpose of this study was to better delineate the blood supply to the bone and skin to allow for a safe and effective harvest.Materials and MethodsTwenty three lower extremities were injected with latex or a mixture of latex and barium sulfate. The SLGA was identified and dissected, documenting the course, diameter, anatomical relations, length and branches. In the mixture group, high resolution CT scanning was done prior to dissection. Two additional specimens were dissected to illustrate the harvest technique.ResultsThe SLGA originated from the popliteal artery at an average of 44.3mm proximal to the knee joint line. The SLGA had an average diameter at origin of 1.9mm and length of 56mm. It coursed posterior to the femur reaching the lateral intermuscular septum (IMS), dividing into superficial (patellar) and deep (condylar) branches, which coursed towards and gave branches to the patella and the LFC respectively. At least one (average 1.4) septocutaneous skin perforator >5mm emerged and ran posterior to the IMS. 3D reconstructions of the CT scans were used to confirm anatomic findings and describe a standard harvest technique.ConclusionsThe SLGA has consistent anatomy, adequate length, suitable diameter at origin for microvascular anastomosis, and constant perforators to bone and skin. The LFC flap provides a useful alternative to flaps from the medial knee or iliac crest.



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