Clinical application of superior lateral genicular artery perforator propeller flap in repair of soft-tissue defects around knee joint

Abstract

To explore the feasibility and effectiveness of using the superior lateral genicular artery (SLGA) perforator propeller flap to reconstruct soft-tissue defects around the knee joint. Between October 2013 and May 2019, 10 patients underwent repairing of soft-tissue defects around the knee joint using the SLGA perforator propeller flap. There were 6 males and 4 males, with a median age of 34.5 years (range, 6-66 years). Etiologies included radical tumor resection in 4 cases, post-burn scar contracture in 3 cases, post-burn hypertrophic scar in 2 cases, and prothesis exposure after knee arthroplasty in 1 case. Defects located on the lateral knee in 6 cases, proximal lateral leg in 2 cases, popliteal fossa in 1 cases, and infrapatellar region in 1 case. The size of soft-tissue defects was from 6 cm×4 cm to 14 cm×8 cm. The extraction range of the flap was from 10.0 cm×5.5 cm to 23.0 cm×7.0 cm; the length of the perforator pedicle was 2.5-5.0 cm, with an average of 3.65 cm; the flaps were rotated 180°, the large paddle of the propeller flap was used to repair the defect, and the small paddle was used to assist the closure of donor site. Blister was observed in the distal 3-cm of one flap and the flap survived after conservative management. All the flaps survived, and the wounds in the donor and recipient areas healed by first intention. There was no vascular crisis, incision dehiscence, infection, or other complications. All 10 patients were followed up 4 to 48 months, with an average of 12.6 months. The color and texture of the flap were similar to those of the recipient area, and there was no need for secondary operation for degreasing and thinning. Scar contracture was corrected; no tumor recurrence was found in tumor patients; the artificial knee joint was preserved, the knee joint flexion and extension activities were good, and all the patient and family members were satisfied with the appearance and function of the lower limbs after operation. The SLGA perforator propeller flap surgery is relatively simple without the need of microvascular anastomosis, has the minimal donor-site morbidities, and can provide a compound flap for the repairing of a complex wound. The SLGA perforator propeller flap is one of the optional methods to repair soft-tissue defects around the knee joint.