The descending branch of the lateral circumflex femoral
artery: a reliable and robust alternative blood supply
in the free fibular transfer for avascular necrosis of hip
Hischam M. Taha
Received: 21 July 2011 / Accepted: 24 January 2012 / Published online: 28 February 2012
Abstract Avascular necrosis (AVN) of the femoral head
is a disastrous condition and even more tragic when
affecting the young adult. The fact that AVN has a
number of aetiological trigger conditions underpins the
fact that ultimately there is loss of vascularity to the
caput. Early aggressive treatment through core decom-
pression and vascularised bone grafting has been shown
to successfully arrest disease progression. We describe
here in a patient series the descending branch of the
lateral circumflex femoral artery and vein as reliable
alternative vascular recipient vessels to convention for
receiving the bone flap. Further refinements are des-
cribed to expedite the procedure and promote success.
It is believed that this is the first described experience
of this technique for AVN of the hip.
Keywords Avascular necrosis of hip
Descending branch of LCFA
Avascular necrosis (AVN) of the femoral head is the patho-
logical consequence of femoral head ischaemia. Its aetiology
remains unclear but may be resultant of traumatic or diverse
non-traumatic causes such as alcohol abuse, renal transplant
and steroid prescription .
The progression of this condition leads to femoral head
collapse, loss of joint integrity and associated pain of oste-
oarthritis. Many patients presenting with AVN of the hip are
young physically active adults in whom total hip arthro-
plasty would be undesirable and premature.
Treatment through use of timely core femoral head de-
compression combined with vascularised free fibular bone
grafting is now well established in arresting further femoral
head collapse and alleviating pain [2, 3].
The conventional recipient vessels described for this
procedure is the ascending branch of the lateral circumflex
femoral artery (LCFA) and local veins .
In our experience these are often of small calibre, limited
in potential pedicle length and in a deep constricted anatom-
ical region (the femoral neck) not routinely experienced by
the reconstructive microsurgeon. Collectively these factors
compound the challenge of this procedure.
We present here our alternative technique in a patient
series where these vessels were of such poor quality as to
seriously threaten the viability of the free fibula flap.
Through an initial salvage procedure we found the descend-
ing branch of the lateral circumflex artery as an excellent
local alternative recipient .
As the vascular pedicle of the anterolateral thigh flap 
often described as a workhorse of microsurgery, its anatomy
is very familiar, the vessel calibre and pedicle length robust
H. M. Taha (*)
Department of Plastic Surgery,
Royal Devon and Exeter Hospital (Wonford) NFT,
Exeter EX2 5DW, UK
Department of Plastic Surgery,
Frenchay Hospital North Bristol NHT,
Frenchay Park Road,
Bristol BS16 1LE, UK
Eur J Plast Surg (2012) 35:731–734