Lateral supragenicular pedicle perforator flap: Clinical results and vascular anatomy

Background: The lateral supragenicular artery flap has been previously described for soft-tissue reconstruction around the knee. It provides an excellent alternative to muscle and musculocutaneous flaps with less morbidity. The evolution of the understanding of perforator flap anatomy has increased their clinical use and improved flap design. Methods: The authors present a series of cadaveric anatomic studies to further delineate the anatomy of the lateral supragenicular pedicled perforator (LSGAP) flap. The lateral genicular perforator was injected with barium sulphate to locate and map the perforator vascular territories, zones of perfusion and location in relation to standard bony landmarks. Two case presentations exemplify the clinical application of the anatomic findings. Results: Anatomic dissections and selective injection of the genicular perforator found consistent anatomic attributes of pedicle location, axis of flow, linking vessels and vascular territory. LSGAP flaps were used in the case presentations with excellent flap viability and coverage. Conclusions: The LSGAP is another option for soft-tissue coverage around the knee and poplitaeal fossa. The morbidity is minimal as the donor site may frequently be closed primarily without incurring functional impairment. The anatomy of the lateral supragenicular perforator perforasome is reliable and consistent resulting in an additional dependable flap option in our reconstructive armamentarium for coverage of knee and poplitaeal defects.