Dolph Houben

159 New surgical technique of whole joint VCA 8 with vascular clips (LigaClips:Ethicon LLC, San Lorenzo, Puerto Rico). The femoral vessels were dissected distally until the branches of the superior genicular arteries occurred. The anterior compartment musculature was reflected laterally from the tibia tubercle, to identify the interosseous membrane and cranial tibial artery. The nutrient foramen and associated cranial tibial vessel branches supplying bone were identified on its posterior surface and protected, as was the patellar ligament insertion on the tibial tubercle. The cranial tibial artery and vein were ligated distal to the tibial blood supply, and the tibia and fibula divided at this level, immediately distal to the tibia tubercle and nutrient foramen, at a point 6 cm distal to the joint line. The femur was easily identified from a lateral approach by dissection through the intra-muscular plane of the rectus and vastus lateralis. The femoral osteotomy was made 10cm above the joint line. All proximal muscles were released, leaving a small segment of tendon with knee transplant for later reconstruction. The dissection was completed by identification and preservation of all vascular branches of the superficial femoral artery and vein supplying the distal femur, knee joint capsule and tibia. these included the inferior and superior genicular vessels, popliteal artery and vein, and the cranial tibial vessels. The harvested knee joint included distal femur (Fig. 1.5.), proximal tibia (Fig. 1.4), proximal fibula (Fig. 1.3), femoral artery and vein (Fig. 1.1), popliteal artery (Fig. 1.2), patella with intact cartilage and capsule The initial bone cuts were adjusted on the back table after the defect was created in the recipient for a custom fit. The tibia and femur had an intended 3cm length measured from the joint line and the fibula was shortened just below the fibular head. Figure 1: posterior view of whole knee joint harvested from a porcine cadaver showing: 1) allogenic vascular pedicle, femoral artery with ligated side branches 2) transition femoral to popliteal artery, with superior genicular arteries 3) fibular head 4) tibia plateau 5) femur.