Descending genicular artery free flaps: Multi-purpose tissue transfers in limb reconstruction.

Background: The descending genicular artery supplies skin, muscle, tendon, and bone structures in the medial knee area. Three types of skin perforator including musculocutaneous perforators through the vastus medialis (descending genicular artery perforator (DGAP)-vm), direct cutaneous perforators (DGAP), and saphenous artery perforators (SAP) can be elevated for the skin flap component.

Methods: This study included a prospective cohort of all patients in whom a descending genicular artery free flap was attempted in our center since January 2009. Data on patients' characteristics, type of injuries, the surgical procedures, and their outcomes were obtained for a minimum of 6 months postoperatively.

Findings: This cohort includes 22 descending genicular artery flaps for skin, bone, and tendon reconstruction after extensive soft tissue injury and/or bone nonunion. Of these, six were medial femoral condyle bone grafts, seven were skin flaps from the medial knee, and nine composite osteocutaneous or tendo-osteocutaneous flaps. Favorable outcome was achieved in 20 of 22 cases. We use the DGAP and DGAP-vm in 15 of 16 cutaneous and osteocutaneous flaps.

Conclusion: The descending genicular artery flap offers a wide range of simple and composite flaps. Recognition of all types of skin perforators should enhance the options, the chance of success, and the popularity of the flap.