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Case Report Plastic and Aesthetic Research

Supermicrosurgical reconstruction of knee

defect using superior medial genicular

perforator as a recipient vessel

Hoon Kim
Department of Plastic and Reconstructive Surgery, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine,
Incheon 404834, South Korea.
Address for correspondence: Dr. Hoon Kim, Department of Plastic and Reconstructive Surgery, International St. Mary’s Hospital, Catholic
Kwandong University College of Medicine, 25, 100 Gil, Simgok‑Ro, Seo‑Gu, Incheon 404834, South Korea.
E‑mail: prshoonkim@gmail.com

ABSTRACT
A 24‑year‑old male presented after being involved in a motorcycle accident and was found to have soft
tissue defects of the knee with exposure of patella. Due to the severe injury from the popliteal fossa to the
posterior aspects of the lower leg, repair with a free flap from anterolateral thigh perforator was planned
instead of local calf muscle flap. Preoperative angiography was performed, and it showed that superior
medial genicular perforator was patent compared with unreliable filling of the superior lateral genicular
perforator. The soft tissue defect was repaired using the superior medial genicular perforator as the
recipient vessel. This was performed by creating perforator to perforator anastomosis (supermicrosurgery).
The flap survived successfully, and the patient was able to ambulate in a few weeks without serious
complications. This case indicates that superior medial genicular perforator can be used as the recipient
vessel for covering the soft tissue defects of the knee caused by blunt injury.

Key words:
Soft tissue defect of the knee, superior medial genicular perforator, supermicrosurgery

INTRODUCTION option when there is injury to the donor site endangering
the vascularity. Although the free flaps are less affected
Soft tissue defect of the knee remains challenging and in terms of the donor site selection, selection of the
problematic to reconstructive surgeons. Prerequisite for recipient vessel in the vicinity of knee defect remains
the reconstruction of this region include the flexibility, problematic.
durability and thickness of the skin paddle to sustain Since perforator to perforator anastomosis
the motion of the knee joint. Numerous surgical trials (supermicrosurgery) emerged, this technique has been
have been performed using musculocutaneous flaps, vastly used for reconstructive surgeries without regard to
fasciocutaneous flaps, perforator flaps, and free flaps to the recipient vessel. We report a case using the superior
repair these defects with varying degrees of success. [1‑3] medial genicular perforator as the recipient vessel and

Local flaps created from the calf muscle are preferred supermicrosurgery techniques to cover the soft tissue
primary surgical option. However, local flap may not be an defect of the knee.

CASE REPORT
Access this article online
Quick Response Code:
Website: A 24-year-old male was injured in a motorcycle
www.parjournal.net accident. Patient had a knee injury with soft tissue
defect measuring 12 cm × 7 cm and exposure of the
patella was noted [Figure 1]. Physical examination
DOI:
10.4103/2347-9264.139708 revealed severe contusion of the posterior calf. Because
of these findings, repair using local gastrocnemius

Plast Aesthet Res || Vol 1 || Issue 2 || Sep 2014 81