Vascular coverage of the anterior knee region – an anatomical study

Abstract

Descriptions of vessel angiosomes or perforasomes throughout the human body are quite frequent, and led to the development of flaps nowadays commonly used to surgically cover skin and soft tissue defects. In these procedures, the surgeon requires a profound anatomical knowledge of the respective blood vessels and the extent of the perfused area to define the size of the graft. In the region of the knee joint, descriptions of flaps based on the superior lateral genicular artery and descending genicular artery are quite frequent. In contrast, information regarding other popliteal branches is scarce or non‐existent. The aim of this study was to provide a concise and complete overview on the extent and variability of the perforator angiosomes of the femoral and popliteal arteries in the anterior knee region. Twenty lower extremities were dissected, the respective perforators identified and perfused with dye. All resulting angiosomes were marked and documented. A total of 84 angiosomes were identified in all specimens, with an average of 4.2 (3–6) angiosomes per specimen. The average size of the angiosomes was 97.04 ± 72.30 cm 2 (8.61–360.41 cm 2 ), their source vessels had an average diameter of 1.42 ± 0.54 mm (0.60–3.25 mm). The complex and highly variable distribution of perforator angiosomes of the anterior knee region and especially of its less frequently investigated distal part was demonstrated. Based on these results, the planning of existing perforator flaps in this region and the development of flaps including the inferior medial or inferior lateral genicular arteries may be facilitated.

Free-style Approach to the Pedicled Lower Medial Thigh Perforator Flap

“…The DGA originates from the superficial femoral artery at the level of the adductor hiatus (11.9–17 cm above the joint line) and has a robust branching system that includes the saphenous artery, muscular branches, and osteoarticular branches. 5 , 6 The superomedial genicular artery originates from the popliteal artery at an average of 4 cm above the medial condyle, 2 cm medial to the longitudinal axis of the leg. The origin of the saphenous artery is variable and may be absent.…”

“…When present, it may arise as a branch of the DGA or originate directly from the femoral or popliteal artery. 6 These serve as a reliable source of skin perforators for flaps in the medial knee and distal thigh, with a highly variable angiosome area. Furthermore, many anastomoses exist between these arteries in this region.…”

Revision knee surgery: the practical approach

“…Creation of skin flaps at an acute angle of less than 60° at the intersection of other incisions is a risk for the blood supply. 11 Short skin bridges of less than 6–7 cm between incisions are not recommended. In complex situations with multiple incisions or skin adherence, plastic surgeons should be involved for skin incision design and for muscle flap procedures.…”

Percutaneous Management of Osteoarthritis in the Knee: Proceedings from the Society of Interventional Radiology Research Consensus Panel

“…GAE attempts to target and inhibit angiogenesis that occurs from the proinflammatory state in knee OA. To achieve this, there are 6 vessels that are typically targeted during GAE, which include the medial superior genicular artery, medial inferior genicular artery, lateral superior genicular artery, lateral inferior genicular artery, descending genicular artery, and anterior tibial recurrent artery (36)(37)(38)(39). Studies have demonstrated that all 6 arteries are present in most patients, with asymmetry in size between vessels and collateralization of supply across the joint being both been reported (36)(37)(38).…”