Inferior medial genicular artery based tibia osteocutaneous flap: Anatomic study and clinical application for small...

Area of Science:

• Orthopedic Surgery
• Microsurgery
• Reconstructive Surgery

Background:

• Reconstructing composite digital defects is challenging due to the need for small, short-pedicled flaps.
• The inferior medial genicular artery (IMGA) flap, harvested from the proximal medial tibia with overlying skin, is presented as a novel solution.
• This flap is designed for the reconstruction of small composite tissue defects in digits.

Purpose of the Study:

• To investigate the feasibility of the new IMGA-based vascularized bone flap for digital reconstruction.
• To evaluate the anatomical consistency and surgical application of the IMGA flap.

Main Methods:

• A cadaveric dissection study of 6 lower extremities was performed to analyze IMGA anatomy and pedicle characteristics.
• Surgical techniques were refined, and the flap was applied to 9 patients with small composite tissue defects in digits, metacarpals, and metatarsals.
• Postoperative outcomes were assessed using the Michigan Hand Outcomes Questionnaire (MHQ) scale after an average follow-up of 9.6 months.

Main Results:

• The IMGA flap demonstrated consistent anatomy, enabling the successful reconstruction of 7 osteocutaneous and 2 bone-only defects.
• The average pedicle length was 2.5 cm with an arterial diameter of 1.2 mm; skin island and bone flap sizes were suitable for digital defects.
• Flap survival was high (8/9 patients), with bony union achieved within 2 months and good functional outcomes (average MHQ score 75.95), and minimal donor site morbidity.

Conclusions:

• The inferior medial genicular artery (IMGA) based tibia osteocutaneous flap is described for the first time.
• This technique provides a valuable new option for reconstructive surgeons managing small composite tissue defects.
• The IMGA flap is a feasible and effective method for digital reconstruction with good functional results and low morbidity.