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Reconstructing complex peripatellar defects using the descending genicular artery perforator flap.

Yun-Huan Hsieh1, Doran Kalmin2, Maitumelo Imeldah Motoroko2,3

  • 1Department of Plastic and Reconstructive Surgery, Monash Health, Melbourne, Victoria, Australia.

ANZ Journal of Surgery
|June 19, 2023
PubMed
Summary

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Karydakis Versus Limberg Flap in Primary Sacrococcygeal Pilonidal Sinus: A Retrospective Comparative Study of Functional Recovery.

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Reply: Comparing Innervated and Noninnervated Glabrous Skin Flaps for Volar Digital Defects: Insights from Patient-Reported Outcomes.

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Early and late outcomes of component separation with transversus abdominis release with mesh augmentation versus primary suturing for the management of abdominal dehiscence: a retrospective comparative study.

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Reliability of Postoperative Free Flap Monitoring with a Novel Prediction Model Based on Supervised Machine Learning.

Plastic and reconstructive surgery·2023

The descending genicular artery perforator (DGAP) flap is a safe and reliable option for reconstructing complex peripatellar defects, offering a viable alternative to free flaps in trauma cases.

Area of Science:

  • Orthopedic Surgery
  • Plastic Surgery
  • Reconstructive Surgery

Background:

  • Complex peripatellar defects often require reconstruction.
  • Free or pedicled muscle flaps are common, but pedicled fasciocutaneous perforator flaps are underutilized.
  • The descending genicular artery perforator (DGAP) flap offers thin, pliable tissue ideal for peripatellar reconstruction.

Purpose of the Study:

  • To demonstrate the safe use of a pedicled fasciocutaneous DGAP flap for extensive traumatic peripatellar defect reconstruction.
  • To present surgical pearls for DGAP flap utilization in a case series.
  • To highlight the DGAP flap as a versatile option for peripatellar soft tissue defects.

Main Methods:

  • Retrospective cohort study of complex peripatellar reconstructions using DGAP flaps (January 2011 - December 2018).
Keywords:
descending genicular arteryhigh-velocity knee injuryperforator flapperipatellar reconstructionsaphenous artery

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  • Review of patient demographics, comorbidities, defect characteristics (aetiology, size, location).
  • Clinical assessment of flap, donor site, and overall surgical outcomes; descriptive statistics used.

    • Main Results:

    • Five complex peripatellar defects (5x8 to 8x10 cm) were reconstructed.
    • Cases included trauma (4) and oncological (1) etiologies.
    • All flaps survived with a mean follow-up of 24 months; one patient required a split-thickness skin graft.

    Conclusions:

    • The DGAP flap is a reliable alternative to free flaps for large, complex peripatellar defects.
    • Safe harvesting and utilization are possible, even in high-velocity impact knee injuries, with careful technique.
    • The DGAP flap provides ideal 'like with like' reconstruction for peripatellar soft tissue defects.