Customized reconstruction of a complex soft-tissue defect around the knee with a free perforator flap

Reconstruction of a complex defect around the knee, particularly involving a large soft-tissue defect or disruption of the extensor mechanism, is always a challenging problem. The purpose of this study was to introduce the use of a customized free perforator flap for complex soft-tissue reconstruction around the knee. Between June 2010 and March 2017, 16 patients underwent this procedure. The choice of flap design is based on the location of the wound, the required pedicle length, the missing tissue components and their volumes, and the risk of donor-site morbidity. The reconstruction was performed using anterolateral thigh perforator (ALTP) flaps in five cases, modified ALTP flaps in two cases, chimeric ALTP flaps in four cases, dual-skin paddle ALTP flaps in two cases, and chimeric thoracodorsal artery perforator flaps in two cases. Multiple perforator flaps and vascularized fascia lata were used in one case. All flaps survived postoperatively. No vascular congestion was observed, and partial necrosis was observed in only one case. Primary closure of the donor site was performed for all patients. At a mean follow-up time of 16.5 months, most cases showed satisfactory flap contours and acceptable functional outcomes. A free perforator flap is a reliable option for repairing complex soft-tissue defects in the knee region, especially when local and pedicled flaps are unavailable. Various flap designs allow for more individualized treatment approaches and can achieve better results.