Turbocharged Chimeric Anterolateral Thigh Flap and Vastus Lateralis Double Mini-flaps for Repair of Intractable Fistulae Communicating with the Knee Joint

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The treatment of fistulas communicating with a joint is a challenging issue. We report the case of a fistula communicating with the knee joint that formed after surgery for a traumatic injury. The fistula could not be closed with a pedicled perforator flap ; however, it was successfully closed by using a turbocharged chimeric anterolateral thigh flap and vastus lateralis double mini-flaps.
The diameter of the perforator derived from the distal portion of the descending branch of the lateral circumflex femoral artery ( LCFA ) was very small, and the dominant perforator was derived from the transverse branch ; therefore, to ensure vascular augmentation, the transverse branch was anastomosed with a muscle branch for the rectus femoris diverging from the proximal side of the LCFA.
In addition, a chimeric flap was constructed by using double muscle branches given off from the distal portion of the descending branch of the LCFA, and double fistulas were closed with vascularized double muscle flaps.