The quadriceps Femoris allograft as an extension of the Angiosome concept: A cadaveric‐based anatomical feasibility study

• Published in: Microsurgery 2020-02, Vol.40 (2), p.189-199
• Main Authors: Sparks, David S., Taylor, G. Ian, Gascoigne, Adam, Corlett, Russell J., Ashton, Mark W.
• Format: Article
• Language: English
• Subjects: Ablation; Blood; Blood vessels; Cadavers; Dissection; Feasibility studies; Femur; Knee; Lead oxides; Limbs; Muscles; Myositis; Necrotizing fasciitis; Quadriceps muscle; Radiographs; Transplantation; Transplants & implants; Trauma
• ISSN: 0738-1085; 1098-2752
• DOI: 10.1002/micr.30479

Background Vascularised composite allo‐transplantation (VCA) is emerging as a tailored approach for complex tissue reconstruction. This study focuses on the quadriceps VCA as a potential solution for tissue repair, following trauma, necrotising fasciitis/myositis, or tumor ablation. Methods Dissections were undertaken in 10 adult cadaveric lower limbs to characterize the blood supply to the quadriceps femoris for en bloc muscle allo‐transplantation. A mock cadaveric transplantation was performed to (a) define the best neurovascular VCA design and (b) test the feasibility of the procedure. A review of 54 archival radiograph studies from the institution was also performed to further evaluate the muscle vasculature. Results In two lower limbs, the quadriceps VCA was harvested designed on the common and superficial femoral vessels and nerve, which revealed a lengthy and bloody dissection, especially of the veins, which could increase clinically with the inability to use a tourniquet for most of the dissection. However, review of our previous archival studies showed that all four quadriceps muscles are supplied within the lateral circumflex femoral angiosome. In a further eight lower limbs, the quadriceps femoris muscle group consistently received its blood supply from the lateral circumflex femoral angiosome, verified by selective lead oxide injections of this artery. The vastus medialis appeared to have a more tenous blood supply distally based on this angiosome. A successful mock cadaveric transplant was performed based on this data. Conclusions We suggest that the best neuromuscular quadriceps VCA should be (a) designed on the lateral circumflex femoral pedicle, (b) should be raised from distal to proximal, and (c) should include the descending genicular vessels as a potential supplemental supply to vastus medialis, should all four muscles be required.