Cutaneous angiosome of the chimeric SLGA perforator flap

Cutaneous angiosome of the chimeric SLGA perforator flap – anatomical study and clinical considerations:

Publication date: Available online 2 March 2019

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Clemens Gstoettner, Johannes A. Mayer, Martin Aman, Stefan Salminger, Heinz Bürger, Lena Hirtler, Wolfgang Weninger, Oskar C. Aszmann

Summary

Background

The superior lateral genicular artery (SLGA) is the basis of a chimeric perforator flap in the lateral knee region, which may include bone, cartilage, fascia and/or skin. To our knowledge, the literature is missing a detailed description of the corresponding perforator based skin area. The aim of this study was to describe the extent and possible variations of the cutaneous angiosome of the SLGA.

Methods

In an anatomical study on 21 fresh frozen lower limbs the SLGA was injected with toluidine blue. The anatomy of the vessel and its perforators was explored and the skin containing the cutaneous angiosome harvested and photo-documented. Evaluation of the images was performed using the software ImageJ.

In addition, the versatility of the SLGA perforator flap is illustrated as both a pedicled local and a free tissue transfer.

Results

For each vessel there were 1.75 ±0.9 (range 1-3) perforators, with an average position of 47.3 ±21.3mm lateral to the superolateral patella and 42.5 ±18.7mm proximal to the knee joint. Angiosome area was 222.8 ±57.6cm² with a length of 20.9 ±3.0cm and a width of 15.4 ±3.0cm. At the longitudinal axis of highest perforator density, the proximal end of perfusion averaged 13,4 ±4,1cm proximal and the distal end 2,5 ±2,0cm distal to the knee joint.

Conclusion

Our results show that the SLGA supplies a constant angiosome over the anterolateral proximal knee joint. Its description and visualization will guide surgeons in preoperative planning and further extend the use of this versatile chimeric perforator flap.