title: Effects of ligation of lateral intermuscular septum perforating vessels on blood supply to the femur.
abstract: BACKGROUND
  With a subvastus approach to the femur, the vessels that perforate the lateral intermuscular septum (LISP-vessels) must be ligated. The effect on the blood supply to the femur remains unclear. The purpose of the current study was to investigate the effect of ligation of the LISP-Vessels on the blood supply and to examine the anatomy of the LISP-vessels and the anastomoses around the femur.
  
  
  METHODS
  In six human cadavers the LISP vessels were ligated by a lateral subvastus approach on one side. The contralateral side served as control group. After bilateral injection of different coloured silicon dyes into the lateral and medial circumflex femoral artery (green), deep femoral artery (red) and the superficial femoral artery (blue) dissection was performed bilaterally. The arterial perfusion on both sides was compared and the anatomy of the LISP vessels studied.
  
  
  RESULTS
  The medullary perfusion of the femur was not altered by the ligation of the LISP vessels. It did also not lead to a decrease in periosteal vessel filling. The LISP vessels were shown to be a part of a complex and rich anastomotic network and play an important role in the perfusion of the femur and quadriceps muscle group. The ligature could be compensated for by this anastomotic network. Branches to the periosteum separate from the LISP vessels immediately after perforating the lateral intermuscular septum. The linea aspera turned out to be an important area for the femoral blood supply.
  
  
  CONCLUSIONS
  Exposure of the femur through a lateral subvastus approach with ligation of LISP vessels causes a certain degree of soft tissue trauma. However, by using a gentle surgical technique the periostal perfusion of the femur can be preserved by a potent anastomotic network after ligation of the LISP vessels if they are not ligated to close to the lateral intermuscular septum and the linea aspera is not unnecessarily exposed.
authors.affiliation: Department of Orthopaedic Surgery, Rorschacher Strasse 95, St. Gallen, CH-9007, Switzerland. Electronic address: karl.grob@kssg.ch.
authors.forename: K
authors.initials: K
authors.lastname: Grob
authors.affiliation: Anatomisches Institut der Universität Zürich-Irchel, Switzerland. Electronic address: manestar@anatom.uzh.ch.
authors.forename: M
authors.initials: M
authors.lastname: Manestar
authors.affiliation: Anatomisches Institut der Universität Zürich-Irchel, Switzerland. Electronic address: axel.lang@anatom.uzh.ch.
authors.forename: A
authors.initials: A
authors.lastname: Lang
authors.affiliation: The University of Western Australia, Australia. Electronic address: tim.ackland@uwa.edu.au.
authors.forename: T
authors.initials: T
authors.lastname: Ackland
authors.affiliation: Hollywood Functional Rehabilitation Clinic, Perth, WA, Australia. Electronic address: hgilbey29@gmail.com.
authors.forename: H
authors.initials: H
authors.lastname: Gilbey
authors.affiliation: The University of Western Australia Perth Orthopaedic and Sports Medicine Centre, Australia. Electronic address: family.kuster@bluewin.ch.
authors.forename: M S
authors.initials: MS
authors.lastname: Kuster
mesh_terms: D002102:Cadaver; D005260:Female; D005263:Femoral Artery; D005264:Femoral Fractures / Q000473:pathology / Q000601:surgery*; D005269:Femur / Q000033:anatomy & histology / Q000098:blood supply*; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D007083:Iliac Artery; D008026:Ligation / Q000379:methods*; D008297:Male
keywords: Blood supply to the femur; Femur fracture; Lateral intermuscular septum perforating (LISP) vessels; Plate osteosynthesis; Subvastus approach to the femur