title: The first perforating branch of the deep femoral artery: A reliable recipient vessel for vascularized fibular grafts: An anatomical study.
abstract: BACKGROUND
  Although the perforating branches of the deep femoral artery have been introduced as recipient vessels for vascularized fibular grafts in the treatment of osteonecrosis of the femoral head, comprehensive knowledge of the related anatomy is deficient. The aims of this study were to provide detailed anatomical data for the perforating branches of the deep femoral artery and validate their usefulness as recipient vessels for vascularized fibular grafts.
  
  
  METHODS
  Anatomical dissection was performed on 11 fresh human cadaveric lower extremities. The number, locations, and diameters of the perforating branches were documented. The topographic relationships with the vastus ridge and the tendinous insertion of the gluteus maximus were clarified. The diameters of the perforating branches were compared with those of the ascending branch of the lateral circumflex femoral and the peroneal arteries.
  
  
  RESULTS
  The mean number of perforating branches was 3.5. The mean distances from the vastus ridge to the first, second, and third perforating branches were 8.1, 13.7, and 20.4 cm, respectively. The first perforating branch was always located medial to the tendinous insertion of the gluteus maximus, whereas the second perforating branch was always located distal to the gluteus maximus. The mean diameters of the first, second, third, and fourth perforating branches were 3.1, 2.3, 1.6, and 1.2 mm, respectively. The mean diameters of the ascending branch of the lateral circumflex femoral and the peroneal arteries were 2.0 and 3.6 mm, respectively.
  
  
  CONCLUSIONS
  The first perforating branch of the deep femoral artery is an appropriate alternative recipient vessel for vascularized fibular grafts in the treatment of osteonecrosis of the femoral head. It has a very consistent anatomy with a suitable location and diameter for anastomosis of the peroneal artery.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea.
authors.forename: Yoo Joon
authors.initials: YJ
authors.lastname: Sur
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Assiut University Hospital, Assiut, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Morsy
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA; Restoration of Appearance and Function Charitable Trust (RAFT), UK.
authors.forename: Anita T
authors.initials: AT
authors.lastname: Mohan
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA; Division of Plastic Surgery, Department of Surgery, Peking Union Medical College Hospital, Beijing, People's Republic of China.
authors.forename: Lin
authors.initials: L
authors.lastname: Zhu
authors.affiliation: Department of Anatomy, Mayo Clinic, Rochester, MN, USA.
authors.forename: Nirusha
authors.initials: N
authors.lastname: Lachman
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: msaint-cyr@sw.org.
authors.forename: Michel
authors.initials: M
authors.lastname: Saint-Cyr
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation / Q000379:methods*; D002102:Cadaver; D004210:Dissection; D005260:Female; D005263:Femoral Artery / Q000033:anatomy & histology*; D005271:Femur Head Necrosis / Q000601:surgery; D005360:Fibula / Q000098:blood supply* / Q000637:transplantation*; D006801:Humans; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged
keywords: Anatomical study; Deep femoral artery; Osteonecrosis of the femoral head; Perforating branch; Vascularized fibular graft