Abadeer Andrew I, Hembd Austin, Brooks Daina, Higgins James P, Giladi Aviram M, Shubinets Valeriy
The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
Musculoskeletal Research Center, Department of Orthopedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD.
J Hand Surg Am. 2025 Aug;50(8):915-921. doi: 10.1016/j.jhsa.2025.04.008. Epub 2025 May 23.
The medial femoral trochlea (MFT) flap is a source of vascularized articular cartilage that has most commonly been used for reconstruction of proximal pole scaphoid nonunions and lunate osteonecrosis in Kienbock disease. This study aimed to describe the arterial perfusion of the MFT.
Selective injection of the descending genicular artery (DGA) was performed with radiopaque dye in eight cadaveric lower extremities. Micro-computed tomography was performed on the medial femoral condyle including the MFT segment, with digital analysis quantifying vessel location and internal diameter within the territory of the MFT flap.
All specimens had adequate perfusion up to the MFT from the transverse branch of the DGA. The transverse branch and longitudinal branches of the DGA were of similar caliber (0.45 ± 0.19 and 0.49 ± 0.29 mm, respectively). The segment of bone and cartilage included in MFT harvest had an average of 5.9 ± 1.2 terminal periosteal vessels and 2.8 ± 1.9 nutrient vessels. The greatest number of nutrient vessels to the MFT were contained within 6.3 ± 2.19 mm from the cartilage margin. More nutrient vessels were found penetrating the cortex on the proximal aspect of the trochlea. The nutrient vessels demonstrated a consistent pattern of perfusion penetrating the cortex and coursing perpendicular to the surface of the femur.
The MFT flap is reliably perfused by the transverse branch of the DGA with a rich supply of periosteal and nutrient vessels adjacent to cartilage. These vessels often collateralize with terminal vessels of the longitudinal branch. Periosteal and nutrient vessels to the flap are within 6.3 mm from the edge of the cartilage, which translates to a safe margin for osteotomy/flap harvest.
Understanding MFT microperfusion guides optimal flap harvest by maximizing the capture of osseous perforators.
股骨内侧滑车（MFT）皮瓣是带血管化关节软骨的来源，最常用于舟骨近端不愈合和Kienböck病月骨缺血性坏死的重建。本研究旨在描述MFT的动脉灌注情况。
在8具尸体下肢中，用不透射线的染料对膝降动脉（DGA）进行选择性注射。对包括MFT节段在内的股骨内侧髁进行微型计算机断层扫描，通过数字分析量化MFT皮瓣区域内血管的位置和内径。
所有标本从DGA的横支到MFT均有充足灌注。DGA的横支和纵支管径相似（分别为0.45±0.19和0.49±0.29毫米）。MFT切取所包含的骨和软骨节段平均有5.9±1.2条终末骨膜血管和2.8±1.9条滋养血管。至MFT的滋养血管数量最多的位于距软骨边缘6.3±2.19毫米范围内。在滑车近端发现更多滋养血管穿透皮质。滋养血管呈现出一致的灌注模式，穿透皮质并垂直于股骨表面走行。
MFT皮瓣由DGA的横支可靠灌注，在软骨附近有丰富的骨膜血管和滋养血管供应。这些血管常与纵支的终末血管形成侧支循环。皮瓣的骨膜血管和滋养血管位于距软骨边缘6.3毫米范围内，这为截骨/皮瓣切取提供了安全边界。
了解MFT的微灌注情况有助于通过最大化捕获骨穿支来指导最佳皮瓣切取。
