Lower medial thigh perforator (LMTP) propeller flap for reconstruction of soft tissue defects around the knee

Abstract

Background Skin and soft‐tissue defects around the knee are common and their reconstruction is still challenging and argued. Thin, pliable and well‐vascularized tissues are required in order to restore the aesthetic appearance of the knee and facilitate joint function. Historically local muscle flaps were employed for the upper third of the lower limb reconstruction; however, since their introduction, different perforator flaps have been proposed for this purpose. The aim of this report is to share our clinical experience with the pedicled lower medial thigh perforator (p‐LMT) flap for the reconstruction of skin and soft tissue defects around the knee. Patients and Methods Between August 2013 and July 20, 2018, patients underwent pedicled LMT propeller flap reconstruction for defects around the knee. The subunits of the defects were the suprapatellar, the infrapatellar and patellar area and in two cases a full around the knee defect was reported. Cause of defects included trauma (13), tumor (4) and infection after knee operation (3) and defect sizes ranged from 4 × 3 cm2 to 7 × 8 cm2. Results Flap sizes ranged from 4 × 9 cm2 to 6 × 16 cm2. One to two perforators based on the superficial femoral artery or descending genicular artery were found between the septum of satorius and vastus medialis, or piercing the vastus medialis during dissection. All flaps were rotated 180° in propeller fashion. All the donor sites were primarily closed and no complication at the donor site was detected. In the two cases of the total knee soft tissue defect, a double pedicled flaps reconstruction was required. After a 6 months follow‐up, all the patients in the series achieved a full range of motion. Conclusions Fasciocutaneous flaps are currently the first reconstructive option for the soft tissue defects around the knee. The p‐LMT flap reconstruction in this case series achieved good aesthetic and functional outcomes and this flap may be a valuable option for the reconstruction of the small to medium soft tissue defects around the knee.

“Reverse tensor fascia latae perforator flap for reconstruction of knee defect: Anatomic study by computed tomographic angiography and a case report”

“…Coverage of knee defects is still controversial (Table 3). Mohan et al, 2019;Scaglioni et al, 2020) The position of the defect could allow the use of a peroneal perforator flap but this option appeared unreliable in the context of impaired vascularization. (Ruan et al, 2010) No proper ALT or AMT perforators were found.…”

“…(Gravvanis et al, 2005) Fasciocutaneous perforator flaps present the advantages of less morbidity, and better pliability, and cosmetic outcomes. (Gravvanis et al, 2014; Ruan et al, 2010; Scaglioni et al, 2020; Wiedner et al, 2011; Zheng et al, 2015) Many authors recommend the medial sural artery perforator flap (MSAP) in particular (Gstoettner et al, 2019; Ling et al, 2018). Reverse ALT perforator flaps and Reverse Anteromedial Thigh (AMT) perforator flaps are the leading options currently used to reconstruct extensive defects around the knee.…”

“…The prior medial thigh incision and lateral genicular incision from the previous procedure made all the other fascio‐cutaneous flap options inappropriate (proximally based medial saphenous flap, lower medial thigh perforator flap, superior lateral genicular perforator flap, and medial genicular artery perforator flap). (Gstoettner et al, 2019; Mohan et al, 2019; Scaglioni et al, 2020) The position of the defect could allow the use of a peroneal perforator flap but this option appeared unreliable in the context of impaired vascularization. (Ruan et al, 2010) No proper ALT or AMT perforators were found.The possibility of using a free flap was initially ruled out due to the prior vascular bypasses.…”

“…The advent of perforator flaps has dramatically increased the reconstruction options and are now favored by some authors (Gravvanis et al, 2005). Fasciocutaneous perforator flaps present the advantages of less morbidity, and better pliability, and cosmetic outcomes (Gravvanis et al, 2014;Ruan et al, 2010;Scaglioni et al, 2020;Wiedner et al, 2011;Zheng et al, 2015). Many authors recommend the medial sural artery perforator flap (MSAP) in particular(Gstoettner et al, 2019;Ling et al, 2018).…”

Free-style Approach to the Pedicled Lower Medial Thigh Perforator Flap

“…The lower medial thigh perforator (LMTP) flap was described by Scaglioni et al in 2015 as a free perforator flap for head and neck reconstruction, and later as a propeller flap for knee reconstruction. 4 We present our experience with six cases, using a free-style approach to the pedicled LMTP flap for reconstruction of knee defects.…”