The distal vastus medialis artery - a novel recipient vessel in free flap reconstruction of the knee.

Free flap reconstruction around the knee is challenging given a paucity of suitable recipient vessels. Traditional recipient vessels frequently require specific positioning other than supine (limiting flap selection), have variable anatomy, and are located remotely and necessitate interposition grafts. We present a case series demonstrating successful use of the distal segmental artery to the vastus medialis muscle as a recipient for free flap reconstruction with a CT angiography study to further characterize this vessel. Retrospective analysis of CT angiograms of lower limbs used in reconstructive planning between 2015 and 2021 at a single major plastic surgery department were reviewed by two independent clinicians. The distal segmental vessels supplying the vastus medialis muscle were analyzed. In 64 thighs, a consistent radiologically identifiable distal segmental vessel supplying the vastus medialis was seen in 63 (98.4%) cases. In 33 (51.6%) cases, this branch arose from the descending genicular artery while in 30 (47.6%) cases, it arose from the superficial femoral artery. Therefore, the distal segmental vastus medialis vessel is a consistently identifiable recipient option in free flap reconstruction around the knee. It can be raised in the supine patient with a limited necessary dissection and no functional morbidity from sacrifice. No interposition grafts are required.