The medial circumflex femoral artery (MCFA) usually branches from the deep femoral
artery (DFA). It may also branch from the femoral artery (FA). In this study 100
inguinal regions of 50 cadavers were investigated. In 79 extremities (79%) MCFA
branched from DFA, while in 15 (15%) it branched from FA. In four extremities
(4%) MCFA was found to be double; in each case one of MCFAs branched from
FA and the other from DFA. In one of these four cases the lateral circumflex
femoral artery (LCFA) was also double. In one case we found a common trunk of
DFA and MCFA and in another case a common trunk of MCFA, DFA and LCFA.
Clinicians must be familiar with the variations of this clinically important artery to
improve their success in the diagnosis and treatment of pathologies in the region

Tanyeli, E.

Yildirim, M.

Çelik, H.H.

Üzel, M.

English

Via Medica Journals

Folia Morphol. Vol. 65, No. 3, pp. 209–212Copyright © 2006 Via MedicaISSN 0015–5659www.fm.viamedica.plO R I G I N A L   A R T I C L E209Address for correspondence: E. Tanyeli, Assoc. Prof., MD, Department of Anatomy, Cerrahpaºa Medical Faculty, Istanbul University, 34098,Kocamustafapaºa, Istanbul, Turkey, tel: +90 212 414 30 57, fax: +90 212 414 30 59, e-mail: tanyeli@istanbul.edu.trAn anatomical study of the originsof the medial circumflex femoral arteryin the Turkish populationE. Tanyeli1, M. Üzel2, M. Yildirim1, H.H. Çelik31Department of Anatomy, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey2Vocational School of Health Services, Istanbul University, Istanbul, Turkey3Department of Anatomy, Faculty of Medicine, Hacettepe University, Ankara, Turkey[Received 21 March 2006; Revised 5 May 2006; Accepted 5 May 2006]The medial circumflex femoral artery (MCFA) usually branches from the deep fem-oral artery (DFA). It may also branch from the femoral artery (FA). In this study 100inguinal regions of 50 cadavers were investigated. In 79 extremities (79%) MCFAbranched from DFA, while in 15 (15%) it branched from FA. In four extremities(4%) MCFA was found to be double; in each case one of MCFAs branched fromFA and the other from DFA. In one of these four cases the lateral circumflexfemoral artery (LCFA) was also double. In one case we found a common trunk ofDFA and MCFA and in another case a common trunk of MCFA, DFA and LCFA.Clinicians must be familiar with the variations of this clinically important artery toimprove their success in the diagnosis and treatment of pathologies in the region.Key words: anatomy, variation, deep femoral arteryINTRODUCTIONThe medial circumflex femoral artery (MCFA) hasan important role in supplying blood to the femoralhead and neck, to fatty tissue in the acetabular fos-sa and to the adductor muscles [12, 19]. It usuallyoriginates from the deep femoral artery (DFA)[12, 18, 19]. It can be used in flaps in reconstructivesurgery [2, 6–8, 16, 17]. It can be injured during fem-oral neck fracture or the hip dislocation [12] and it isalso important to avoid injuring it during surgery of thehip joint to prevent necrosis of the femoral head [12].It is used in selective arteriography in idiopathic is-chaemic necrosis of the femoral head to determineits arterial supply [14].The aim of this study was to determine the origins ofMCFA, which is clinically important and widely used. Wediscuss our results in relation to the literature.MATERIAL AND METHODSIn this study we investigated during the period1997 to 2005 the inguinal regions of 50 cadavers, ofwhich 40 were male and 10 were female. The ages ofthe individuals were between 24 and 78 years. Thecadavers were fixed by using 10% formalin injectedfrom the femoral artery. After the inguinal region hadbeen dissected, the femoral artery (FA) and its branch-es were exposed. We also measured the distance be-tween the midpoint of the inguinal ligament (IL) andthe origin of MCFA.RESULTSWe investigated 100 inguinal regions of 50 ca-davers. In 79 extremities (79%) MCFA was found tobranch from DFA. In 15 extremities (15%) MCFA wasfound to branch from FA.210Folia Morphol., 2006, Vol. 65, No. 3In 4 extremities (4%) MCFA was found to bedouble; in each case one of MCFAs branched fromFA and the other from DFA. In one of these fourextremities the LCFA was also double (Fig. 1) whilein the other three it was single. In one of the ex-tremities with a double MCFA there were additionalvariations, as the inferior epigastric and deep cir-cumflex iliac arteries branched from FA (Fig. 2).In 1 extremity (1%) MCFA had a common trunk withDFA and branched from FA (Fig. 3). In one other ex-tremity (1%) MCFA, DFA and LCFA had a common trunkwhich branched from FA as a trifurcation (Fig. 4).Apart from the branching patterns we measured thedistance of the branching point of MCFA from the mid-point of IL. In the cases which showed a normal branch-ing pattern the mean distance between the midpointof IL and the branching point of MCFA from DFA was5.9 ± 1.5 cm (3.4–8.1 cm). In the cases in which MCFAbranched directly from FA the mean distance betweenthe midpoint of IL and the branching point of MCFAfrom FA was 2.5 ± 1.4 cm (0.8–4.2 cm).Figure 1. Photograph of the case with double medial and doublelateral circumflex femoral arteries: 1 — femoral artery, 2 — deepfemoral artery, 3 — superior medial circumflex femoral arterybranching from the femoral artery, 4 — inferior medial circum-flex femoral artery branching from the deep femoral artery,5 — femoral vein (cut), 6 — superior lateral circumflex femoralartery branching from the femoral artery, 7 — inferior lateral cir-cumflex femoral artery branching from the deep femoral artery,Sm — sartorius muscle, Pm — pectineus muscle.Figure 2. Photograph of the case with double medial and doublelateral circumflex femoral arteries together with deep circumflexiliac and inferior epigastric arteries branching from the femoral ar-tery: 1 — femoral artery, 2 — deep femoral artery, 3 — superiormedial circumflex femoral artery branching from the femoral artery,4 — inferior medial circumflex femoral artery branching from thedeep femoral artery, 5 — superior lateral circumflex femoral arterybranching from the femoral artery, 6 — inferior lateral circumflexfemoral artery branching from the deep femoral artery, 7 — externalpudendal artery, 8 — inferior epigastric artery, 9 — deep circumflexiliac artery, Fv — femoral vein, IPm — iliopsoas muscle.Figure 3. Common trunk formation between the medial circum-flex femoral and the deep femoral arteries: 1 — femoral artery,2 — deep femoral artery, 3 — medial circumflex femoral artery,4 — lateral circumflex femoral artery.Figure 4. The case with trifurcation: 1 — femoral artery, 2 — trifur-cation, 3 — lateral circumflex femoral artery, 4 — deep femoralartery, 5 — medial circumflex femoral artery, 6 — external pu-dendal artery.211E. Tanyeli et al., The medial circumflex femoral arteryDISCUSSIONMCFA, which shows different branching patterns,is an important artery in supplying blood to the headand neck of the femur, to the adductor muscles andto fatty tissue in the acetabular fossa [12, 19].Because of its close relationship with this area thereis a high risk of severing the artery after trauma orduring operations such as total hip arthroplasty [3, 9,13, 15]. It also has great importance in plastic sur-gery operations as the vascular pedicle of grafts suchas the transverse upper gracilis (TUG) flap, the super-medial thigh flap and the medial circumflex femoral(gracilis) perforator free flap [2, 6, 8]. It is used inselective arteriography in idiopathic ischaemic necro-sis of the femoral head to determine the arterial sup-ply of the femoral head [14].The normal origin of MCFA is from DFA. Whenwe compared our data with the literature we founddifferent results. In our study a normal pattern wasobserved in 79% of the cases. Lippert and Pabstfound it in 58% [10], Adachi in 63.2% [1], Siddharthet al. in 63% [18], Massoud and Fletcher in 81% [11]and Emura et al. in 61.7% [5]. In their angiographicstudy Başar et al. found the normal pattern in 40.9%of cases [4]. Our results are therefore closest to thoseof Massoud and Fletcher [11].MCFA may also branch from FA. We found thispattern in 15% of our cases. Lippert and Pabst foundit in 18% [10], Adachi in 14% [1], Siddharth in 26% [18],Massoud and Fletcher in 6.4% [11] and Emura et al.in 11.6% [5].Cases with a double MCFA are rare. We found thispattern in 4% of our cases. In the literature we wereunable to find much evidence of double MCFAs. Apartfrom our findings this pattern was found only in thestudy of Siddharth et al. [18] in 1% of cases.In one case (1%) we also found a common ori-gin of DFA and MCFA. In the literature we foundthe same pattern only in Adachi’s [1] study, wherethis variation is reported in 4% of cases. Emura etal. [5] also described a similar case in their studywith ascending and descending branches of LCFAarising from FA as additional variations.In one case (1%) we found a trifurcation of DFA,MCFA and LCFA from a common trunk from FA (Fig. 4).We were unable to find any comparable case in theliterature. The most similar case that we could findwas the common origin of these three arteries fromFA in the study by Siddharth et al. [18], in which itwas reported as occurring in 5% of cases.In the literature it is possible to find cadavericand angiographic studies concerning MCFA. Theangiographic studies are valuable but their resultsmay be inconsistent with the results of the cadav-eric studies. The literature includes an angiographicstudy of MCFA in the Turkish population [4] butwe were unable to find any cadaveric studies onthe same population. Our intention in the presentstudy was to fill this gap. Our result for the nor-mal origin of MCFA from DFA is fairly consistentwith the results of other cadaveric studies in dif-ferent populations [1, 5, 10, 11, 18]. The percent-age of cases in our study with a normal origin ofMCFA (79%) is higher than in the angiographicstudy in the same population (40.9%) [4].In our study the distance between the branchingpoint of MCFA and the midpoint of IL was also mea-sured. We were unable to find any information aboutthis distance in other studies [1, 5, 10, 11, 18]. In thecases with MCFA branching directly from FA the meandistance (2.5 ± 1.4 cm) was smaller than in the casesin which MCFA branched from DFA (5.9 ± 1.5 cm).These distances may be useful for clinicians dealingwith this artery.MCFA can be used in flaps in reconstructive sur-gery [2, 6–8, 16, 17] or in selective arteriography inidiopathic ischaemic necrosis of the femoral headto determine its arterial supply [14]. It can be in-jured during femoral neck fracture or hip disloca-tion or in surgery of the hip joint [12]. To preventnecrosis of the femoral head it is important to takecare that the artery is not severed. Because of itsimportance its normal and variational anatomyshould be borne in mind if undesirable outcomesare to be avoided.In our study we both investigated the patternsand measured the distance of branching of MCFA inthe Turkish population. We compared our resultswith other studies and found some patterns whichnot previously reported and for this reason considerit useful to publish these findings and share themwith our colleagues.REFERENCES1. Adachi B (1928) Das Arteriensystem der Japaner, Band II.Verlag der Kaiserlich, Kyoto, p. 145.2. Arnež ZM, Pogorelec D, Planinšek F, Ahèan U (2004)Breast reconstruction by the free transverse gracilis(TUG) flap. Br J Plast Surg, 57: 20–26.3. Aust JC, Bredenberg CE, Murray DG (1981) Mechanismsof arterial injuries associated with total hip replace-ment. Arch Surg, 116: 345–349.4. Başar R, Sargon MF, Cumhur M, Bayramoglu A,Demiryürek D (2002) Distinct intergender difference in thefemoral artery ramification patterns found in the Turkishpopulation: angiographic study. Anat Sci Int, 77: 250–253.212Folia Morphol., 2006, Vol. 65, No. 35. Emura S, Shoumura S, Ishizaki N, Yamahira T, Ito M,Chen HY, Isono H (1989) The anatomical study on thebranches of the femoral artery (II). Comparison withthe findings of Adachi’s classification. KaibogakuZasshi, 64: 196–205.6. Hallock GG (2003) The medial circumflex femoral (gra-cilis) local perforator flap — a local medial groin per-forator flap. Ann Plast Surg, 51: 460–464.7. Hallock GG (2004) Further experience with the medialcircumflex femoral (gracilis) perforator free flap. J Re-constr Microsurg, 20: 115–122.8. Har-Shai Y, Hirshowitz B, Marcovich A, Eliachar I, Peretz BA(1984) Blood supply and innervation of the supero-medial thigh flap employed in one-stage reconstruc-tion of the scrotum and vulva — an anatomical study.Ann Plas Surg, 13: 504–510.9. Langer R, Langer M, Scholz A, Astinet F, Schwetlick G,Felix R (1993) Femoral head perfusion in patients withfemoral neck fracture and femoral head necrosis.J Belge Rad, 76: 145–149.10. Lippert H, Pabst R (1985) Arterial variations in man:classification and frequency. JF Bergman Verlag,München, p. 61.11. Massoud TF, Fletcher EWL (1997) Anatomical variantsof the profunda femoris artery: an angiographic study.Surg Radiol Anat, 19: 99–103.12. Moore KL (1999) Clinically oriented anatomy. 3rd ed.Williams and Wilkins, Baltimore, pp. 188, 545.13. Nachbur B, Meyer RP, Verkkala K, Zurcher R (1979)The mechanisms of severe arterial injury in surgery ofthe hip joint. Clin Orthop Relat Res, 141: 122–133.14. Oide T (1979) Selective medial circumflex femoral arteri-ography in idiopathic ischemic necrosis of the femoral headin adults. Nippon Seikeigeka Gakkai Zasshi, 53: 293–305.15. Pai VS (1996) Compartment syndrome of the but-tock following a total hip arthroplasty. J Artroplast,11: 609–610.16. Rab M, Mader N, Kamolz LP, Hausner T, Gruber H,Girsch W (1997) Basic anatomical investigation ofsemitendinosus and the long head of biceps femo-ris muscle for their possible use in electrically stimu-lated neosphincter formation. Surg Radiol Anat, 19:287–291.17. Ramasastry SS, Liang MD, Hurwitz DJ (1989) Surgicalmanagement of difficult wounds of the groin. SurgGynecol Obstet, 169: 418–422.18. Siddharth P, Smith NL, Mason RA, Giron F (1985) Vari-ational anatomy of the deep femoral artery. Anat Rec,212: 206–209.19. Williams PL, Warwick R, Dyson M, Bannister LH (1989)Gray’s anatomy. 37th ed. Churchill & Livingston, Lon-don, pp. 781–783.

An anatomical study of the origins of the medial circumflex femoral artery in the Turkish population

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An anatomical study of the origins of the medial circumflex femoral artery in the Turkish population

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