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osteomyocutaneous flap from the medial femoral condyle The DGA was absent in 7 cases. In 3 other cases, the DGA
in the reconstruction of bony defects associated with appeared together with the SGA. The SGA was present in
avascular contracture of the soft tissue. 10 cases (25%). The DGA was dominant over the SGA in 33

Although prior studies have described the composite of 40 cases (82.5%). In the remaining 7 cases (17.5%), the
osteomyocutaneous flap, the detail blood vessels in SGA was the major blood supply to the medial femoral
this region have not yet been fully elucidated. The aim condyle.
of this study was to evaluate the anatomical variability The DGA usually divided into branches; there were
of the vessels and their branches in the medial femoral 11 (33.3%) cases of 2 branches, 21 cases (63.7%) of 3
condyle. Board of Hue Central Hospital approved the study. branches and 1 (3%) case of 4 branches. The branches
were the articular branches (AB), the SBs, and the MBs.
METHODS The mean position of the DGA was 119.1 mm above
the knee joint with a range of 96.2–148.8 mm (standard
Ten fresh and 10 formalin preserved adult cadavers deviation [SD] 23.6 mm). The mean outer diameter of the
were dissected in our study, consisting of 11 males and DGA was 2.16 mm (range, 0.94–3.84 mm; SD 0.69 mm).
9 females. Forty cadaveric specimens were harvested From its origin to the onset of branching, there was
from both thighs. The osteomyocutaneous medial a mean length of 11.7 mm (range, 0–40.33 mm; SD
femoral condylar flap was elevated using the medial 8.61 mm) [Figure 1].
approach initially described by Sakai and Doi. [4,5,8]
Cadavers were placed into the supine position and a All 33 cases (100%) of the DGA sent AB to the periosteum
15 cm longitudinal incision was made medially along of the medial femoral condyle. The AB further divided
the posterior border of the vastusmedialis at the level into smaller branches to the periosteum, with 1 branch
of the distal femur, extending from the adductor hiatus in 19 cases, 2 branches in 13 cases, and 3 branches in 1
proximally to the medial collateral ligament distally. [9-12] case. The mean location of its origin was 100.7 mm above
The fascia of the vastusmedialis was then incised, and the knee joint with a range from 70.3 to 129.4 mm (SD
the muscle was retracted superiorly while the adductor 13.4 mm). Its average length from the origin to the bone
magnustendon was retracted inferiorly. The DGA was was 56.4 mm (range, 23.8–80.5 mm; SD 14.4 mm). The
exposed on the floor of the muscle compartment mean outer diameter was 1.5 mm (SD 0.4 mm). The mean
proximally and on the surface of the medial femoral area of the periosteum of the medial femoral condyle that
condyle distally. The SGA, a medial branch of the the AB perfused was 37.8 mm × 25.7 mm [Figure 2].
popliteal artery, was also studied. The anatomy of the
DGA and SGA with their branches and their areas of In 39 (97.5%) cases the MB supplied blood to the distal
distribution were dissected, measured, and documented. aspect of the vastusmedialis muscle, and in 1 case the
For the DGA, the length, location of origin, diameter, MB entered the gracilis muscle. In 25 cases (62.5%) the
branches and terminations in the skin as well as in MB was a branch from the DGA, in 14 cases (36%) it came
the periosteum overlying the medial femoral condylar from the SFA, and in 1 case it branched off the AB. The
region were determined. A dominant artery between mean length of the MB was 16.8 mm (SD 6.5 mm). The
the DGA and SGA was defined as a main artery supply mean outer diameter was 1.6 mm (SD 0.9 mm).
to the medial femoral condyle. [7,13] The position of the In 37 specimens (92.5%) the SB supplied the skin at
artery was measured as the distance from the origin to the medial part of the knee and the proximal leg. In 3
the knee joint. The length of the artery was defined as specimens from the fresh cadavers, the SB ran to the
the distance from its origin to the area of termination.
The outer diameter (d) of the artery was calculated gracilis muscle instead of toward the skin. The SB came
through the perimeter (P) of the peripheral arteries by off the DGA in 26 (70.3%) cases and the SFA in 11 (29.7%)
the following formula: d = P/3.14. cases. The mean location of the origin of the SB was
103 mm (SD 18.5 mm). Its mean outer diameter was
The perimeter was calculated by flattening the artery at 1.3 mm (SD 0.4 mm). Ten SB had 1 branch, and 27 SB
its origin and using a digital caliper (Anyi Instrument Co. had 2 branches to the skin at the medial part of the
Ltd, China) to measure its flat section, and then doubled. knee and the proximal part of the leg. In 13 specimens
In the fresh cadavers, we also performed a dye injection from the fresh cadavers, methylene blue was injected.
at the origin of the articular and SBs of the DGA. This A cutaneous angiosome distribution of the SB was noted
allowed visualization of the areas of the corticocancellous on the medial aspect of the knee and proximal leg.
medial femoral condylar segment and skin paddle. [14,15] The average perfusion area at the level of the skin was
All measurements were recorded in millimeters, with an 244 mm × 115 mm [Figure 3].
accuracy of 0.02 mm.
The superomedial genicular artery (SGA) existed in
RESULTS 10 (25%) specimens, and it was dominant over the DGA in
7 cases (17.5%). The mean outer diameter was 1.33 mm (SD
The anatomical structures differed on the two sides of the 0.4 mm). The mean location of its origin was 88.5 mm (SD
thigh in the cadavers. The DGA origin from the superficial 17.8 mm) above knee joint. The mean length of the SGA to
femoral artery (SFA) was found in 33 of 40 cases (82.5%). the periosteum was 37.5 mm (SD 16.9 mm).

86 Plast Aesthet Res || Vol 1 || Issue 3 || Dec 2014