Arterial and lymphatic supply of the knee integuments

The surgical approach to the anterior knee region carries a risk for postoperative integument infection and skin necrosis. A hypothesis is that surgical approach may damage integumental blood supply and additionally the lymphatic drainage from the foot and leg. The goal of this study was to describe the arteries and lymphatics directly affected by the antero-medial approach. Injection of the femoral a. was used to identify the femoral and popliteal aa. and their branches distributed to the integument of the anterior, medial and lateral aspects of the knee. Lymphatic injection into the plantar aspect of the first toe was also performed to identify the subdermal lymphatics traversing the area. Our results showed that most of the blood supply arises from the medial aspect of the knee integuments. However, subcutaneous arterial anastomoses provide a significant blood-supply when there is interruption of the medial vessels as seen in the medial surgical approach to the knee. Most of the lymphatic drainage originating from the foot crosses the knee region on the medial side, opposite or below the tibial tuberosity. Because the subdermal arterial network is well-developed, the medial approach for knee surgery does not endanger the anterior knee integuments as long as the lateral vascular supply is preserved. However, this approach may interrupt the lymphatic circulation, particularly in the case of an extended incision, which could explain postoperative edema and an increased rate of wound infection.