Reconstructing complex peripatellar defects using the descending genicular artery perforator flap

Complex peripatellar defects are commonly reconstructed with free flaps or pedicled muscle flaps, whereas pedicled fasciocutaneous perforator flaps are commonly overlooked. The descending genicular artery perforator (DGAP) flap is a versatile flap that offers thin and pliable tissue that provides ideal 'like with like' peripatellar soft tissue defect reconstruction. This paper aims to demonstrate the safe use of a pedicled fasciocutaneous DGAP flap for extensive traumatic peripatellar defect reconstructions and to exhibit the surgical pearls via a case series.

A retrospective cohort study of consecutive complex peripatellar reconstructions with DGAP flaps was conducted from January 2011 to December 2018. Patient demographics, medical comorbidities, aetiology/size/and location of the defects were reviewed. Flap, donor site, and overall surgical outcomes were clinically assessed and documented. Descriptive statistics were conducted and analysed by IBM SPSS Statistics 23.

Five consecutive cases with complex peripatellar defects (5 × 8 to 8 × 10 cm) were recruited. Two were males, and three were females, with a mean age of 38.4 years. Four were trauma, and one was an oncological case. Descending genicular artery (DGA) perforators and DGA terminal branches were consistent. One patient needed a split-thickness skin graft to reconstruct the secondary defects. All the flaps survived with an average follow-up of 24 months.

The DGAP flap provides a reliable alternative to free flap for the large, complex peripatellar defect. With the inclusion of the proximal long saphenous vein and judicious selection of DGA perforators and its terminal branches, the DGAP flap can be harvested and used safely in the high-velocity impacted knee.