Iorio Matthew L, Masden Derek L, Higgins James P
The Curtis National Hand Center, Union Memorial Hospital, 3333 North Calvert Street, Mezzanine, Baltimore, MD 21218, USA.
J Hand Surg Am. 2011 Oct;36(10):1592-6. doi: 10.1016/j.jhsa.2011.07.015. Epub 2011 Aug 26.
The medial femoral condyle (MFC) vascularized corticoperiosteal flap has been well described for the treatment of nonunion with minimal bone loss. Recent applications of this donor site as a corticocancellous flap for large intercalary defects bring into question the vascular territory of bone supplied by the descending genicular artery (DGA). This study's purpose is to delineate the proximal extent of periosteal blood supply of the medial column of the femur provided by the DGA system.
In 18 cadaveric specimens, the DGA was isolated, measured, and cannulated. Using subtraction techniques of fluoroscopic angiography, the vascular network and proximal-most extent of periosteal perfusion were recorded using radiopaque contrast dye.
The DGA branched from the superficial femoral artery 14.2 ± 2.4 cm proximal to the joint line of the knee. The length of the vascular pedicle to its attachment onto the periosteum was 7.7 ± 2.2 cm. All specimens demonstrated a filigree of periosteal vessels dominated by a transverse and a longitudinal branch at the level of the condyle. Proximal perfusion was consistently noted by a large, longitudinal medial metaphyseal periosteal artery. The medial metaphyseal periosteal artery demonstrated that the proximal-most perfusion of the DGA was 13.7 ± 1.3 cm proximal to the joint line. Average femur length was 47.1 ± 3.1 cm. The DGA provided perfusion of 29% ± 2% of the total length of the medial femur.
The DGA provides a large and reliable region of periosteal perfusion, suggesting that corticocancellous MFC harvest might provide the benefits of vascularized bone for large, intercalary nonunion defects conventionally treated with fibula flaps.
Harvest of MFC osseous flaps extending up to 13.7 cm proximal to the joint line can be perfused from the DGA pedicle. The MFC donor site might, therefore, be a reliable option for vascularized reconstruction of larger bone defects.
股骨内侧髁（MFC）带血管蒂骨膜瓣已被充分描述用于治疗骨量极少的骨不连。该供区作为皮质骨松质骨瓣用于大的节段性骨缺损的最新应用引发了对膝降动脉（DGA）所供应骨的血供范围的质疑。本研究的目的是描绘由DGA系统提供血供的股骨内侧柱骨膜血供的近端范围。
在18个尸体标本中，分离、测量并插管DGA。使用荧光透视血管造影的减法技术，用不透射线的造影剂记录血管网络和骨膜灌注的最近端范围。
DGA在膝关节线近端14.2±2.4 cm处从股浅动脉分出。血管蒂附着于骨膜的长度为7.7±2.2 cm。所有标本均显示在髁水平有以横向和纵向分支为主的骨膜血管细网。近端灌注始终由一条大的纵向内侧干骺端骨膜动脉实现。内侧干骺端骨膜动脉显示DGA的最近端灌注在关节线近端13.7±1.3 cm处。股骨平均长度为47.1±3.1 cm。DGA提供了股骨内侧总长度29%±2%的灌注。
DGA提供了一个大且可靠的骨膜灌注区域，这表明切取皮质骨松质骨MFC可能为传统上用腓骨瓣治疗的大的节段性骨不连缺损提供带血管蒂骨的益处。
切取延伸至关节线近端达13.7 cm的MFC骨瓣可由DGA血管蒂灌注。因此，MFC供区可能是大骨缺损带血管蒂重建的可靠选择。
