Anatomy of the medial femoral circumflex artery and its surgical implications

Anatomy of the medial femoral circumflex artery and its surgical implicationsSir, I write with reference to the paper by Gautier et al 1 entitled 'Anatomy of the medial femoral circumflex artery and its surgical implications' in the July 2000 issue.The authors have attempted to focus attention on the importance of knowledge of the blood supply of the upper end of the femur in surgical practice.The paper is based on anatomical dissections of 12 fresh cadavers and it is supported by 52 references made in en bloc form.Many of the statements which the authors make, however, are not supported by the work of other researchers, for example, "The deep branch of the MFCA gives rise to two to four superior retinacular vessels and occasionally, to inferior retinacular vessels."The work of Trueta and Harrison 2 was shown to be flawed many years ago by Lagrange and Dunoyer 3 whose work is not quoted in the references, and by Crock 4 and Chung 5 .The fact that multiple retinacular vessels have not been demonstrated by the present authors may indicate that they were not fully injected during the preparation of the specimens, rather than that they are absent.Another statement made is: "Despite previous descriptions, 9,12,14,17,18,[20][21][22]24,49 we found no anastomotic branch surrounding the neck of the femur . . .."The ten cited references are merely listed, and several are outstanding anatomical works which disprove this claim.Unfortunately, this paper simply perpetuates fallacies about the blood supply of the upper end of the femur since it is based on the use of inadequate anatomical techniques.Also, the five authors thank six co-workers for technical assistance and friendship, raising serious questions about multiauthorship.For example, who did the dissections, and who accepts the academic responsibility for conclusions drawn from the work?