title: A composite osteomusculocutaneous free flap from the medial femoral condyle for reconstruction of complex defects.
abstract: This combined anatomic and clinical study illustrates the first experiences of an osteomyocutaneous flap from the medial femoral condyle for reconstruction of composite tissue defects. We analyzed the anatomic consistency and the vascular distribution of this flap and showed that muscle tissue can easily be added as a composite flap. Twenty-one flaps were harvested from fresh adult cadavers with careful identification of the origin and the course of the three different branches of the descending genicular artery. The corresponding skin areas and muscle portion were identified. The clinical application of this flap was described for closure of complex calcaneal defects. The cadaveric study presented a constant pedicle length and diameter of the arteries, combined with a constant venous drainage. Furthermore, the medial condyle provided a corticocancellous segment and separate vascularity for skin and muscle portions. In the case reports, satisfying results of bone union and soft tissue contouring were achieved. The medial femur condyle region is a reliable donor site for composite flaps, providing a good corticocancellous bony structure and a separate skin paddle, as well as a muscle portion. Its vascular distribution shows anatomic consistency. Despite long-term atrophy of muscle transplants, we believe the additional muscle tissue improves the reconstruction results and provides better soft tissue contouring.
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery/Burn Center-Tuebingen, BG-Traumacenter, Germany. a.rahmanian@web.de
authors.forename: Afshin
authors.initials: A
authors.lastname: Rahmanian-Schwarz
authors.forename: Vinzent
authors.initials: V
authors.lastname: Spetzler
authors.forename: Amro
authors.initials: A
authors.lastname: Amr
authors.forename: Matthias
authors.initials: M
authors.lastname: Pfau
authors.forename: Hans-Eberhard
authors.initials: HE
authors.lastname: Schaller
authors.forename: Bernhard
authors.initials: B
authors.lastname: Hirt
mesh_terms: D000328:Adult; D000368:Aged; D016025:Bone Transplantation / Q000379:methods*; D002102:Cadaver; D002111:Calcaneus / Q000293:injuries / Q000601:surgery*; D004210:Dissection; D004838:Epiphyses / Q000601:surgery / Q000637:transplantation*; D005260:Female; D005269:Femur / Q000601:surgery; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000379:methods; D050723:Fractures, Bone / Q000601:surgery; D058752:Free Tissue Flaps / Q000098:blood supply*; D006801:Humans; D015601:Injury Severity Score; D007719:Knee Joint / Q000033:anatomy & histology / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D018570:Risk Assessment; D016038:Skin Transplantation / Q000379:methods; D017695:Soft Tissue Injuries / Q000175:diagnosis / Q000601:surgery; D020858:Tissue and Organ Harvesting; D016896:Treatment Outcome