Muscle-chimaeric medial sural artery perforator flap: a new design for complex three-dimensional knee defect

Reconstructions of composite and three-dimensional knee defects remain challenging. Gastrocnemius musculocutaneous flaps have been widely used for complex knee-defect reconstruction, but problems of donor-site morbidity and bulkiness of flaps remain. In the present study, we designed a new muscle-chimaeric medial sural artery perforator flap and applied the technique in a clinical case. A gastrocnemius muscle segment with sufficient pedicle length was obtained by intramuscular dissection of the vascular pedicle. The muscle segment was then utilised to fill the underlying dead space and the remaining soft tissue and skin defects were reconstructed with the perforator skin flap. The flap survived completely and wound healing progressed smoothly without infection, haematoma or seroma. Our patients were satisfied with their aesthetic outcomes and did not experience any donor-site morbidity. The muscle-chimaeric medial sural artery perforator flap is a valuable option for the reconstruction of composite and three-dimensional knee defects.