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Figure 1: Preoperative finding shows soft tissue defect of the left knee Figure 2: Conventional angiography shows the abrupt cutoff with
measuring 12 cm × 7 cm with patella exposure retrograde filling of the superior lateral genicular perforator compared
with intact superior medial genicular perforator (SMGA: superior medial
genicular artery, SLGA: superior lateral genicular artery)

Figure 3: Supermicrosurgical anastomosis of one artery (0.6 mm) and
two veins (0.4 mm, 0.7 mm) with 10‑0 and 11‑0 nylon was made in an
end‑to‑end fashion (a: artery, v: vein)
Figure 4: Acceptable functional and aesthetic appearance was obtained
musculocutaneous flap was excluded to avoid unreliable at postoperative month 11
vascularity of the donor site. Instead, a free flap
reconstruction using a vessel in the vicinity of the knee The flap survived successfully, and the patient had
as the recipient was planned. functional ambulation within 15 days after surgery

Conventional angiography instead of computed without any complications. Full flexion of the knee joint
tomographic angiography was performed to predict the was achieved by postoperative week 4. Patient was also
direction of vascular flow around the traumatized knee. able to squat without any discomfort. The patient was
It showed abrupt cutoff with retrograde filling of the satisfied with the contour of the flap at postoperative
superior lateral genicular perforator compared with intact month 11 [Figure 4].
superior medial genicular perforator [Figure 2]. Using the
intraoperative hand‑held Doppler, perforator of superior DISCUSSION
medial genicular artery was targeted and identified.
Elevation of anterolateral thigh perforator free flap with Reconstruction of soft tissue defects surrounding the
3 cm pedicle length was performed and the superior knee has been well-known for its difficulty and strenuous
medial genicular perforator was identified under a nature of the process. Damage to the soft tissue around
microscope. Perforator to perforator anastomoses of one the knee can be caused by trauma, cancer resection, and
artery (0.6 mm, descending branch of lateral circumflex the exposure of prosthesis.
femoral artery with superior medial genicular artery) Several musculocutaneous flaps including gastrocnemius,
and two veins (0.4 mm and 0.7 mm, venae comitantes) sartorius, vastus medialis, and vastus lateralis flaps
with 10-0 and 11-0 nylon were made in an end-to-end have been applied successfully to cover the soft tissue
fashion [Figure 3]. Donor site was closed with meshed defect of the knee. Other fasciocutaneous flaps, island
allogeneic dermal matrix, followed by split thickness skin flaps and perforator flaps based on the sural artery,
graft (0.3048 mm). superior lateral genicular artery, and the reverse flow of

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