Kohlhauser Michael, Vasilyeva Anna, Bürger Heinz, Anderhuber Friedrich, Kamolz Lars-Peter, Schintler Michael
Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
Division of Hand Surgery, Private Hospital Maria Hilf, Klagenfurt am Woerthersee, Austria.
Bone Joint Res. 2025 Sep 19;14(9):795-804. doi: 10.1302/2046-3758.149.BJR-2024-0536.R2.
The reconstruction of complex defects involving various tissues still presents a challenge for reconstructive surgery and makes a combined flap indispensable. The mediodistal femur region (MDFR), which is supplied by the descending genicular artery (DGA), represents a unique donor site for harvesting combined flaps. This study analyzes the vascular anatomy of this region and the possible types of combined flaps.
Within this analysis, the vascular supply of the DGA in a total of 35 lower limbs was investigated, having been embalmed with the Walter Thiel technique in order to enable lifelike conditions.
The DGA was detectable in 100% (n = 35) of all instances. The artery divided into three branches in 48.57% (n = 17) of cases and two branches in the remaining cases. In 40% (n = 14) of cases we found a saphenous artery (SA) and a musculoarticular branch (MAB), in 8.57% (n = 3) an articular branch (AB) and a muscular branch (MB), and in 2.86% (n = 1) a SA and a MB. Usage of DGA branches enabled corticoperiosteal, corticocancellous, osteochondral, or osteocutaneous flaps in 100% (n = 35) of our cases, and myocorticoperiostal, osteomyotendinous, osteomyotendocutanous, or osteotendofasciocutaneous flaps in 97.14% (n = 34). Vascular supply of skin flaps was feasible via the SA in 100% (n = 35) of cases or via dermal branches of the AB in 37.14% (n = 13).
The multitissue, distal-mediofemoral region, supplied by the DGA and its branches, offers an optimal donor site with reliable vascularization, enabling the harvesting of combined flaps.
复杂组织缺损的重建对整形外科来说仍是一项挑战，这使得联合皮瓣成为不可或缺的选择。由膝降动脉（DGA）供血的股骨中远端区域（MDFR）是获取联合皮瓣的独特供区。本研究分析该区域的血管解剖结构以及联合皮瓣的可能类型。
在本分析中，共对35条下肢的DGA血管供应情况进行了研究，这些下肢采用沃尔特·蒂尔技术进行防腐处理，以呈现逼真的状态。
在所有病例中，DGA的检出率为100%（n = 35）。在48.57%（n = 17）的病例中，该动脉分为三个分支，其余病例中分为两个分支。在40%（n = 14）的病例中，我们发现了隐动脉（SA）和肌关节支（MAB），在8.57%（n = 3）的病例中发现了关节支（AB）和肌支（MB），在2.86%（n = 1）的病例中发现了SA和MB。在我们所有病例（n = 35）中，利用DGA分支均可获取骨膜、骨皮质、骨软骨或骨皮瓣，在97.14%（n = 34）的病例中可获取肌骨膜、骨肌腱、骨肌腱皮或骨腱筋膜皮瓣。在100%（n = 35）的病例中，通过SA可为皮瓣提供血供，在37.14%（n = 13）的病例中，可通过AB的皮支为皮瓣提供血供。
由DGA及其分支供血的多组织股骨中远端区域是一个具有可靠血供的理想供区，能够获取联合皮瓣。
