Superior medial genicular artery (SMGA): a recipient vessel for free-flap reconstruction of anterior and medial knee defects.

摘要

Successful free flap reconstruction of soft tissue defects around the knee is highly dependent on the choice of recipient vessel. Traditionally an end-to-side anastomosis to the popliteal artery has been used. This can create problems associated with difficult dissection, patient positioning, long vascular pedicle, tunnel compression of the pedicle and the multiple anastomoses associated with vein grafting.Thus alternative recipient vessels have been described including the sural vessels and branches of the superficial femoral artery such as the descending genicular artery (DGA). All these vessels also have disadvantages which include superficial location, need for vein grafting and/or an intra-muscular course.The SMGA is predictable in it's anatomical location, present in most individuals, lies deep alongside the femoral metaphysis (thus escaping damage when the distal femur is injured), is close to the defect to be reconstructed which avoids vein grafting, allows supine or lateral patient positioning, does not have an intra-muscular course and is consistently 1 mm or more in diameter as it passes anteriorly. We have also found it to have good flow so it can sustain large free-flaps.