J Reconstr Microsurg 1996; 12(1): 1-4
DOI: 10.1055/s-2007-1006444
ORIGINAL ARTICLE

© 1996 by Thieme Medical Publishers, Inc.

A Surgical Guide for Identifying the Lateral Femoral Circumflex Vessels During Free Vascularized Fibular Transfer for Avascular Necrosis of the Femoral Head

Todd M. Swenson, James R. Urbaniak, Dean G. Sotereanos
  • Department of Orthopaedic Surgery, University of Pittsburgh, Pennsylvania and Division of Orthopaedic Surgery, Duke University, Durham, North Carolina
Further Information

Publication History

Accepted for publication 1995

Publication Date:
08 March 2008 (online)

ABSTRACT

Free vascularized fibular transfer for avascular necrosis of the femoral head was developed in an attempt to preserve, rather than replace, the femoral head. In this procedure, the peroneal vessels of the autogenous fibular graft are anastomosed to recipient branches of the lateral femoral circumflex vessels. A problem with this procedure has been the difficulty in locating the lateral femoral circumflex vessels. An anatomic and surgical study was conducted to seek a consistent anatomic landmark for use in isolating these vessels.

Ten cadaveric and 29 surgical hip dissections were performed. A falx, or fascial band, was consistently found approximately 10 cm distal to the anterior superior iliac spine; it is attached to the anterior intertrochanteric line of the proximal femur, with additional attachments to the investing fascia of the tensor fascia lata and rectus femoris muscles. Cautious release of this falx from superficial to deep leads to the fat layer surrounding the lateral femoral circumflex vessels.

This study has shown that an anatomic landmark exists, which consistently leads to location of the lateral femoral circumflex vessels during a free vascularized fibular transfer. By incorporating the use of this landmark into the authors' surgical technique, they have significantly reduced surgical dissection time and have provided a safe method for isolating the recipient vessels during this challenging operation.