Angiosomes of the medial femoral condyle: Anatomical study of cutaneous perforators.

Abstract

The vascularized corticoperiosteal medial femoral condyle flap is widely used in reconstructive microsurgery; however, intraoperative perfusion frequently differs from static anatomical expectations. Despite widespread clinical use, quantitative data on descending genicular artery perfusion territories and functional behavior of inter-perforator connections under controlled perfusion conditions remain limited. Twenty fresh, unfixed human lower extremities underwent selective arterial cannulation and controlled sequential perfusion in a standardized ex-vivo model. A stepwise perfusion protocol (synchronous, isolated, and flow-reversal conditions with controlled proximal inflow and distal occlusion) was used to characterize territorial perfusion behavior and perforator morphometry. Perforator morphometry was recorded, and inter-perforator connectivity was classified according to perfusion response patterns rather than histophysiological confirmation. The descending genicular artery was consistently present and gave rise to saphenous, muscular, and articular branches, with relevant branching variability observed. In 30% of limbs, one of these branches-most frequently the saphenous-originated independently from the femoral artery, indicating relevant variability for pedicle planning. Under synchronous perfusion, the mean perfused cutaneous territory measured 312.6 cm² (210.6-415.6 cm²). Ninety-eight cutaneous perforators (4.9 ± 1.1 per limb) were identified; mean diameter was 0.70 ± 0.24 mm with pedicle length of 3.6 ± 0.8 cm, indicating consistent anatomical availability for flap harvest. These findings indicate that the descending genicular artery behaves as a dynamic perfusion field rather than a fixed angiosome and should be interpreted intraoperatively as a condition-dependent vascular territory, with implications for skin paddle design and flap planning.