Reconstruction of Small to Medium-Sized Soft Tissue Defects Around The Knee or Proximal Third of The Lower Leg with The Adipofascial Flap Based on The Superficial Lateral Sural Artery-4 Case Reports and Literature Review

Background: Reconstruction of soft tissue defects around the knee and tibia is always difficult. Adequate soft tissue coverage after bony stabilization is of the utmost importance for a successful outcome.Aim and Objectives: We describe 4 cases in which the superficial lateral sural artery flap was used for coverage over knee or tibia. Materials and Methods: The case reports consist of 4 patients, 3 men and 1 woman with an average age 47 years (25-79) and with an median follow-up time of 7.7 months (3-12). In three of the cases, aetiology was a lower limb injury caused by trauma. The last one was caused by septic arthritis after total knee arthroplasty. The technique is based on the use of the superficial lateral sural artery flap. The flap was designed as adipofacial flap fashion and transposed to cover the defect around the knee or tibia. The raw surface of the transposition flap was resurfaced with split-thickness skin graft. Donor site was allowed to be closed primarily. Results: All flaps survived. A postoperative hematoma occurred in one case, which is healed with evacuation. The donor site healed uneventfully in three cases. Exception was that one had minimal necrosis of donor site but it healed after wound care. Sensory loss of the dorsolateral aspect of the foot occurred, but they tolerate it well during the follow-up period in all cases. Conclusions: The superficial lateral sural artery flap is useful for reconstruction of soft tissue defects around the knee and on the proximal third and middle third of the lower leg. It is a relatively easy and reliable procedure.