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descending branch of lateral femoral circumflex artery Further investigation with larger cases should be
have also been used. [4‑6] However, bulky contour of performed for validation. Nevertheless, this case implies
the flap, functional impairment of the donor site, and the use of supermicrosurgical techniques and superior
discomfort on ambulation due to the scar extended from medial genicular perforator as an alternative to repair soft
the donor site to the knee may be encountered with tissue defect surrounding the knee when the conservative
these flaps. local flap technique may not be reliable.
To avoid these drawbacks, several free flaps have been REFERENCES
introduced. [7‑9] However, free flaps using the source vessels
may threaten the vascularity around the traumatized 1. Zheng HP, Lin J, Zhuang YH, Zhang FH. Convenient coverage of soft‑tissue
knee joint. The evolution of microsurgical techniques defects around the knee by the pedicled vastus medialis perforator flap.
has allowed surgeons to anastomose vessels between J Plast Reconstr Aesthet Surg 2012;65:1151‑7.
perforators that are smaller than 0.8 mm in caliber. 2. Liu TY, Jeng SF, Yang JC, Shih HS, Chen CC, Hsieh CH. Reconstruction of
These techniques are termed as supermicrosurgery. the skin defect of the knee using a reverse anterolateral thigh island flap:
cases report. Ann Plast Surg 2010;64:198‑201.
Hong and Koshima used this refined technique on 25 3. Fujiwara T, Chen CC, Ghetu N, Jeng SF, Kuo YR. Antegrade anterolateral
soft tissue defects over knee joint and minimized donor thigh perforator flap advancement for soft‑tissue reconstruction of the
site morbidity. However, their promising results are 4. knee: case report. Microsurgery 2010;30:549‑52.
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Heo C, Eun S, Bae R, Minn K. Distally based anterolateral‑thigh (ALT)
extremely dependent on the expertise of the surgeon. flap with the aid of multidetector computed tomography. J Plast Reconstr
They preferred free style reconstruction without Aesthet Surg 2010;63:e465‑8.
identifying the recipient vessels, while they could easily 5. Dai J, Chai Y, Wang C, Wen G. Proximal‑based saphenous neurocutaneous
find the recipient vessels in the plane between the fascia flaps: a novel tool for reconstructive surgery in the proximal lower leg and
knee. J Reconstr Microsurg 2013;29:373‑8.
and muscle. 6. Wiedner M, Koch H, Scharnagl E. The superior lateral genicular artery flap
for soft‑tissue reconstruction around the knee: clinical experience and review
In this report, we demonstrate the use of conventional of the literature. Ann Plast Surg 2011;66:388‑92.
angiography to identify superior medial genicular 7. Kim JS, Lee HS, Jang PY, Choi TH, Lee KS, Kim NG. Use of the descending
perforator vessel as the recipient in this patient. To branch of lateral circumflex femoral artery as a recipient pedicle for coverage
of a knee defect with free flap: anatomical and clinical study. Microsurgery
the best of our knowledge, this is the first case of 2010;30:32‑6.
supermicrosurgical reconstruction using superior medial 8. Fang T, Zhang EW, Lineaweaver WC, Zhang F. Recipient vessels in the free
genicular perforator as a recipient vessel. Although 9. flap reconstruction around the knee. Ann Plast Surg 2013;71:429‑33.
Hong JP, Koshima I. Using perforators as recipient vessels
this procedure is technically demanding, the use of (supermicrosurgery) for free flap reconstruction of the knee region. Ann
conventional angiography to identify the recipient vessels Plast Surg 2010;64:291‑3.
made it less tasking. Compared to conventional local flap
modalities, this technique creates less scarring, providing How to cite this article: Kim H. Supermicrosurgical reconstruction of
better contour of the knee and decreased discomfort on knee defect using superior medial genicular perforator as a recipient
vessel. Plast Aesthet Res 2014;1:81-3.
ambulation. The patient could flex the knee joint fully and
perform exercises such as squats without any discomfort Source of Support: Nil, Conflict of Interest: None declared.
in four weeks. Received: 11-05-2014; Accepted: 15-07-2014

Plast Aesthet Res || Vol 1 || Issue 2 || Sep 2014 83