Clinical application of anterolateral thigh flap in wound around the knee with descending genicular artery as the recipient vessel

Objective To explore the clinical application of anterolateral thigh flap transplantation in repairing wound around the knee with descending genicular artery as the recipient vessel, when anterior or posterior tibial vessel could not be utilized. Methods From January, 2015 to May, 2017, free anterolateral thigh flaps obtained from anastomosis of descending genicular artery and great saphenous vein were transplanted to repair the skin soft tissue defect around the knee combined with tendon and bone exposure in 7 patients, after preoperative color Doppler sonography ultrasound (CDU) for precise positioning. There were 4 males and 3 females, with the flap area ranging from 18.0 cm×8.0 cm-38.0 cm×8.0 cm. All of the donor sites were sutured directly. Postoperative followed-up was done termly. Results All the patients were followed-up for 6 to 14 months, with an average of 8.9 months. Typically, 2 cases had large defect areas, with distal flap necrosis of 6.0 cm and 4.0 cm, respectively, which were resected and achieved secondary skin graft healing on the residual surface. Additionally, 4 cases had completely survived flaps and achieved secondary skin graft healing on the residual surface. The remaining 1 case had completely survived flap, but the distal flap near the anteromedial tibia developed bone exposure as a result of the complicated osteomyelitis. As a result, the patient received gastrocnemius myocutaneous flap to repair the wound. Conclusion Anterolateral thigh flap transplantation in repairing skin soft tissue defect wound around the knee, with descending genicular artery as the recipient vessel, can achieve satisfactory clinical efficacy, which can serve as one choice for flap repair in wound around the knee. Key words: Anterolateral thigh flap; Descending genicular artery; Knee joint; Transplantation