Journal of plastic, reconstructive & aesthetic surgery : JPRAS · 2026
Angiosomes of the medial femoral condyle: Anatomical study of cutaneous perforators.
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Tinhofer Ines E, Pagani Andrea, Prantl Lukas, Hirtler Lena, Meng Stefan, Tzou Chieh-Han J, Weninger Wolfgang J
Аннотация
BACKGROUND: The vascularized corticoperiosteal medial femoral condyle flap is widely used in reconstructive microsurgery; however, intraoperative perfusion frequently differs from static anatomical expectations. Despite widespread clinical use, quantitative data on descending genicular artery perfusion territories and functional behavior of inter-perforator connections under controlled perfusion conditions remain limited.
METHODS: Twenty fresh, unfixed human lower extremities underwent selective arterial cannulation and controlled sequential perfusion in a standardized ex-vivo model. A stepwise perfusion protocol (synchronous, isolated, and flow-reversal conditions with controlled proximal inflow and distal occlusion) was used to characterize territorial perfusion behavior and perforator morphometry. Perforator morphometry was recorded, and inter-perforator connectivity was classified according to perfusion response patterns rather than histophysiological confirmation.
RESULTS: The descending genicular artery was consistently present and gave rise to saphenous, muscular, and articular branches, with relevant branching variability observed. In 30% of limbs, one of these branches-most frequently the saphenous-originated independently from the femoral artery, indicating relevant variability for pedicle planning. Under synchronous perfusion, the mean perfused cutaneous territory measured 312.6 cm² (210.6-415.6 cm²). Ninety-eight cutaneous perforators (4.9 ± 1.1 per limb) were identified; mean diameter was 0.70 ± 0.24 mm with pedicle length of 3.6 ± 0.8 cm, indicating consistent anatomical availability for flap harvest.
CONCLUSIONS: These findings indicate that the descending genicular artery behaves as a dynamic perfusion field rather than a fixed angiosome and should be interpreted intraoperatively as a condition-dependent vascular territory, with implications for skin paddle design and flap planning.
METHODS: Twenty fresh, unfixed human lower extremities underwent selective arterial cannulation and controlled sequential perfusion in a standardized ex-vivo model. A stepwise perfusion protocol (synchronous, isolated, and flow-reversal conditions with controlled proximal inflow and distal occlusion) was used to characterize territorial perfusion behavior and perforator morphometry. Perforator morphometry was recorded, and inter-perforator connectivity was classified according to perfusion response patterns rather than histophysiological confirmation.
RESULTS: The descending genicular artery was consistently present and gave rise to saphenous, muscular, and articular branches, with relevant branching variability observed. In 30% of limbs, one of these branches-most frequently the saphenous-originated independently from the femoral artery, indicating relevant variability for pedicle planning. Under synchronous perfusion, the mean perfused cutaneous territory measured 312.6 cm² (210.6-415.6 cm²). Ninety-eight cutaneous perforators (4.9 ± 1.1 per limb) were identified; mean diameter was 0.70 ± 0.24 mm with pedicle length of 3.6 ± 0.8 cm, indicating consistent anatomical availability for flap harvest.
CONCLUSIONS: These findings indicate that the descending genicular artery behaves as a dynamic perfusion field rather than a fixed angiosome and should be interpreted intraoperatively as a condition-dependent vascular territory, with implications for skin paddle design and flap planning.