The Descending Branch of the Lateral Circumflex Femoral Artery: A Practical Alternative Recipient Vessel for Free Flap Phalloplasty and Genitopelvic Reconstruction-an Anatomical Cadaveric Study.

[INTRODUCTION] Free flap phalloplasty and genital reconstruction have advanced significantly since the first reported case in 1982. Commonly used flaps include the radial forearm, anterolateral thigh (ALT), and ulnar forearm. However, less attention has been given to recipient vessel selection, which is critical for surgical success. This study evaluates the descending branch of the lateral circumflex femoral artery (DLCFA) as a potential recipient artery. We reviewed its reliability, anatomical characteristics, and suitability relative to established recipient vessel systems, including the deep inferior epigastric artery (DIEA) and the femoral artery.

[METHODS] Cadaveric dissections were performed with thigh incision to expose the rectus femoris and vastus lateralis muscles, allowing identification and dissection of the DLCFA and its venae comitantes. The DLCFA was transposed toward the pubic region to simulate its use in genital reconstruction. The great saphenous vein (GSV) was also dissected and transposed as its potential for venous supercharging. Sensory nerves, including superior and median perforator branches, were noted for potential coaptation.

[RESULTS] The DLCFA was consistently present, was easily accessible, and could be transposed to the pubic region without significant risk to nearby structures. Compared to the DIEA and femoral artery, the DLCFA was more superficial and simpler to dissect. It allowed for end-to-end anastomosis, which is technically less complex than the end-to-side technique required for larger-caliber arteries. These features suggest reduced intraoperative difficulty and potential for fewer complications.

[DISCUSSION] The DLCFA presents several distinct advantages. Unlike the DIEA, its dissection avoids the intra-abdominal space, thereby reducing the risk of hernia formation or visceral injury. Although its caliber is smaller than that of the femoral artery, the DLCFA facilitates microsurgical handling and anastomosis. Its relatively superficial course, compatibility with venous supercharging via the GSV, and potential for sensory nerve coaptation further underscore its suitability as a recipient vessel in genital reconstruction.

[CONCLUSION] The DLCFA represents a reliable, readily accessible, and anatomically favorable recipient vessel for free flap phalloplasty and pelvic reconstruction. Its utilization may decrease operative complexity and enhance surgical outcomes, supporting its consideration as a preferred recipient vessel in appropriate clinical contexts.