The saphenous artery and vein were ligated and transected at the medial genicular region. Thereafter, at the medial thigh the gracilis and caudofemoralis muscles, at the posteromedial thigh the semitendinosus, semimembranosus and the medial head of the gastrocnemius muscles were divided from their insertions into the proximal tibia and distal femur. The posterior tibial nerves were transected and the popliteal artery and its tibial branches were ligated and transected. Superior genicular artery was identified and preserved at this level, The tendon of quadriceps femoris muscle (patellar ligament) was transected at the anterior thigh and the muscle was stripped proximally gently to protect the integrity of the periosteum. At the lateral side of the thigh tensor fascia lata muscle, which is attached to the lateral capsule was detached, as well as was the joint capsule. Biceps femoris muscle and the lateral head of the gastrocnemius muscle were divided posterolaterally, the cruciate ligaments within the joint were transected and finally the femur was disarticulated from the tibia.

The rat was placed in the lateral position on the table. First, gluteus maximus, tensor fascia lata and biceps femoris muscles were removed. Subsequently, abductor muscle group including quadratus femoris, internal and external obturator, and inferior and superior gemellus muscles were transected from their insertions. The femoral head was dissected out from the acetabulum after transection of the gluteus medius, gluteus minimus and piriformis muscles from their insertion at the greater trochanter. Two branches of the hypogastric artery, medial and lateral circumflex arteries, nourish the femoral neck and head. These arteries cannot be preserved since they arise from the hypogastric artery. Thus, femoral bone was disarticulated from the hip joint and the surrounding muscles were removed with the exception of rectus femoris muscle anteriorly, and adductor magnus, adductor longus, adductor brevis and pectineus medially. To be able to preserve the femoral bone survival, a small cuff of these muscles mentioned above should be preserved at their insertion points. Just on top of the rectus femoris and adductor magnus muscles there is femoral artery and its muscular branch. During the transection of the femoral vessels at the level of the inguinal ligament these muscles can be safely separated from their origin. Thus, all of the nourishing arteries of the femur could be preserved during the femoral bone flap isolation.

Composite flap was flushed with cold heparinized saline (50 U in 10 ml) after transaction of the femoral vessels. A 4 × 5 cm defect was created in the anterior abdominal and medial thigh region of the recipient to accommodate the donor skin flap. The bone flap was placed in the inguinal region parallel and inferior to the inguinal ligament in an oblique position. In order to minimize the vascular pedicle tension, femoral head was positioned inferolaterally (Fig. 25.2c). Since the restricted inguinal space prevents excessive movement and twisting of the pedicle no tacking suture was required. End to end anastomosis of the femoral vessels was performed using standard microsurgical technique and 10/0 nylon. Skin was sutured in an interrupted fashion with 4/0 absorbable suture (Vicryl®, Ethicon, Inc.).