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Cohen-Shohet et al. Plast Aesthet Res 2019;5:28 I http://dx.doi.org/10.20517/2347-9264.2019.030 Page 9 of 13

Figure 12. Traumatic wound of the left lower extremity after a motor vehicle collision. There were three separate wounds connected by
skin bridges

Figure 13. Freestyle propeller perforator flap designed off a superior lateral genicular artery perforator. The flap was isolated on the
perforator and islandized

The benefits of the Kiss flap technique include improved donor sites with adequate soft tissue coverage. This
often negates the need for grafting and therefore improves functional outcomes on the lower extremity,
especially over joint surface. Shortcomings include complex design of flap and potential for tedious
perforator dissections in order to receive adequate closure.

Figure 12 shows a 45-year-old female after a motor vehicle collision with multiple traumatic injuries
including an open left knee joint. After adequate debridement, there were three separate wounds on
the lateral portion of the knee with significant soft tissue loss. First, a freestyle propeller perforator flap
was raised based off a perforator from the superior lateral genicular artery [Figures 13 and 14], which
was rotated inferiorly. To repair the secondary donor site and the more proximal parts of the defect, an
anterolateral thigh flap based on a single perforator was raised and advanced distally in V-Y fashion to
repair the donor site [Figure 15]. The patient had complete closure of all defects as well as the donor site
[Figure 16].