The Role of the Medial Vastus Branch of the Descending Genicular Artery as a Recipient for Free Flap Transfer: Anatomical Study and Clinical Application

BACKGROUND: Free flap reconstruction after wide resection of sarcomas around the knee is challenging due to anatomical complexity and limited recipient vessels. The medial vastus branch of the descending genicular artery (DGA) may serve as a favorable recipient artery, but its anatomical characteristics and clinical applicability remain unclear. MATERIALS AND METHODS: An anatomical study was conducted on 30 lower limbs from 15 formalin-fixed cadavers to investigate the course and diameter of the medial vastus branch of the DGA. In addition, a clinical case of free anterolateral thigh flap transfer using this artery for knee reconstruction following sarcoma resection was presented. RESULTS: The medial vastus branch was identified in 86.7% of specimens, with an average diameter of 1.4 mm (range: 1.0-1.7 mm), 1.6 mm (range: 1.2-1.9 mm), 1.7 mm (range: 1.3-2.0 mm), and 1.9 mm (range: 1.6-2.3 mm), at 2.5, 5.0, 7.5, and 10-cm above the medial upper margin of the patella. Its superficial location allowed for easy dissection and anastomosis. In the clinical case, end-to-end arterial anastomosis between the ALT flap and the medial vastus branch was successfully performed. The flap survived completely without complications, and the patient regained near-normal knee function within seven months postoperatively. CONCLUSION: The medial vastus branch of the DGA is a reliable recipient artery for free flap reconstruction around the knee. Its favorable anatomical characteristics enable safe dissection and vascular anastomosis without the need for positional changes during surgery. This vessel may be a valuable option for complex soft tissue reconstructions around the knee defects.