Medium to large soft tissue defects around the knee joint are increasingly common with the ongoing advances in complex trauma management, implant-related technology, and treatments of cancers including sarcoma. Such defects continue to be a reconstructive challenge in plastic surgery. Utilization of local flaps are inherently limited by flap size, while free flap reconstructions are limited by the paucity of recipient vessels available around the knee joint.
The superiorly based sural artery pedicled flap (SSAF) is based on the superficial sural artery, an anatomically consistent vessel travelling in the subfascial plane along the midline of the calf. Raised as a fasciocutaneous flap, the SSAF has a wide arc of rotation when pivoted at midline of the popliteal crease, making it a versatile solution for soft tissue coverage for defects around the knee joint.
We present a retrospective descriptive study of soft tissue defects around the knee joint reconstruction with the SSAF.
Fourteen patients with medium and large soft tissue defects around the knee joint were recruited across two centres. Patient demographics, operative, and post-operative details were recorded. The SSAFs were raised in various geometries based on the reconstructive requirement of the soft tissue defects which ranged from 50x60mm to 180x90mm in size. The average operative duration was 150 mins, and patients were discharged from the hospital around post-operative day five. Two patients who received skin grafts at the donor site sustained partial graft loss. There were no cases of coverage failure.
We described the applications of the SSAF which provides pliable soft tissue reconstruction for optimal aesthetic and functional outcomes. Being a single-staged procedure with minimal donor site morbidity and a short operative duration, the SSAF is a reliable and replicable option in the reconstructive algorithm, particularly for patients with significant co-morbidities and institutions with limited resources.