The reversed-flow medio-distal fasciocutaneous island thigh flap: anatomicbasis and clinical applications

A new fasciocutaneous reversed-flow island flap of the thigh is presented w hich is independent of the presence of perfused blood vessels below the lev el of the knee joint-line. The pedicle, which is supplied by the proximal g enicular anastomotic network, consists of the osteoarticular branch (OAB) a nd concomitant veins of the descending genicular artery. Based on cadaver d issections the OAB arose in 23/30 specimens (77%) together with the sapheno us artery (SA). In 2/30 specimens (7%) the OAB originated directly from the superficial femoral artery and in 1/30 specimens (3%) the OAB was absent. The OAB gave off one to three cutaneous branches to the overlying skin in 2 6/30 specimens (87%). We were able to elevate a flap on the osteoarticular branch alone in 57%. Additional length could be added to the pedicle in 33% by including the most proximal part of the saphenous artery together with its first cutaneous branch. Thus, in 90% of the dissections a reversed-flow island flap could be raised which reached the proximal half of the leg, th e knee and the most distal part of the thigh. We report our early clinical experience.