Repair of severe peri-knee soft tissue defect using an anterolateral thigh flap with the descending genicular vessels as the recipient pedicle: a case series of 14 patients

Background The application of free skin flaps to repair severe peri-knee soft tissue defects is a common clinical approach. This article aims to investigate clinical efficacy and precautions of using a free anterolateral thigh flap with the descending genicular vessels as a recipient pedicle for repairing Gustilo IIIB and IIIC soft tissue defects around the knee. Methods We retrospectively analyzed the data of the patients with severe peri-knee Gustilo IIIB or IIIC soft tissue defects operated on from January 2015 to December 2019. All patients underwent repair of the severe soft tissue defect using anterolateral thigh flap transplantation with the descending genicular vessels as the recipient pedicle. Results All patients completed effective follow-up for an average of 14.1 [6-30] months. For two patients with larger flaps, necrosis occurred in the distal tip of the flaps, 6 cm and 4 cm in size. The necrotic flaps were removed, and the wound healed after skin grafting. In the other 12 patients, the skin flaps fully survived. Conclusions Using a free anterolateral thigh flap with descending genicular vessels as the recipient pedicle to repair Gustilo IIIB and IIIC soft tissue defects around the knee is a convenient and preferred technique that can achieve satisfactory efficacy.