An analysis of the medial femoral condyle flap anatomy and the involvement of different tissue components for the reconstruction of complex defects

Aims The reconstruction of complex defects involving various tissues still presents a challenge for reconstructive surgery and makes a combined flap indispensable. The mediodistal femur region (MDFR), which is supplied by the descending genicular artery (DGA), represents a unique donor site for harvesting combined flaps. This study analyzes the vascular anatomy of this region and the possible types of combined flaps. Methods Within this analysis, the vascular supply of the DGA in a total of 35 lower limbs was investigated, having been embalmed with the Walter Thiel technique in order to enable lifelike conditions. Results The DGA was detectable in 100% (n = 35) of all instances. The artery divided into three branches in 48.57% (n = 17) of cases and two branches in the remaining cases. In 40% (n = 14) of cases we found a saphenous artery (SA) and a musculoarticular branch (MAB), in 8.57% (n = 3) an articular branch (AB) and a muscular branch (MB), and in 2.86% (n = 1) a SA and a MB. Usage of DGA branches enabled corticoperiosteal, corticocancellous, osteochondral, or osteocutaneous flaps in 100% (n = 35) of our cases, and myocorticoperiostal, osteomyotendinous, osteomyotendocutanous, or osteotendofasciocutaneous flaps in 97.14% (n = 34). Vascular supply of skin flaps was feasible via the SA in 100% (n = 35) of cases or via dermal branches of the AB in 37.14% (n = 13). Conclusion The multitissue, distal-mediofemoral region, supplied by the DGA and its branches, offers an optimal donor site with reliable vascularization, enabling the harvesting of combined flaps. Cite this article: Bone Joint Res 2025;14(9):795–804.