Related Experiment Video
Updated: Mar 9, 2026
Vascularized Composite Hand Allograft Procurement and Preparation for Distal and Proximal Forearm Allotransplantation: A Stepwise Approach
Published on: May 23, 2025
Upper and lower extremity reconstructive applications utilizing free flaps from the medial genicular arterial system:
Nikolas H Kazmers1, Stephanie Thibaudeau2, Zvi Steinberger3
1Department of Orthopaedics, University of Utah, Salt Lake City, Utah.
Background:
Free flaps derived from the medial genicular artery (MGA) system, including the medial femoral condyle (MFC) and medial femoral trochlear (MFT) flaps, are potential reconstructive options to address upper and lower extremity bony pathology. Our primary aim was to comprehensively search the literature to describe the spectrum of pathology treated with these flaps, and to assess patient outcomes to improve our understanding of expected union and complication rates.
Methods:
Following PRISMA guidelines, a systematic review using Pubmed and Embase databases with citation cross-referencing was performed to identify all original clinical articles characterizing MGA flap treatment of upper and lower extremity pathology.
Results:
The initial search identified 173 articles which was narrowed down to 40 meeting inclusion criteria, representing a total of 248 cases: 174 and 74 in the upper and lower extremities, respectively. Sixteen distinct recipient sites were identified with union rates ranging from 66 to 100% (98.7% overall). The majority (83.9%) of patients had undergone prior failed surgery. Major complications (those with limb/flap loss or requiring unplanned reoperation) were more frequent for lower versus upper extremity applications (17.1% vs. 6.2%, respectively). Donor site femoral fracture or persistent knee dysfunction occurred in 0.8% and 0.4% of patients, respectively.
Conclusions:
MGA free flaps are a versatile option for upper and lower extremity osseous reconstruction, offering high rates of union with minimal complications for a complex patient population. This study furthers our understanding of patient outcomes following MGA flap reconstruction, which previously was limited to case reports and small case series.
