2016 Volume 29 Issue 4 Pages 266-272
The combined use of a free superior gluteal artery perforator flap and the medial sural artery for popliteal reconstruction in two cases is described.
Case 1 : The patient was a 79-year-old male. A long-lasting widespread burn scar of the lower leg exhibited repeated ulceration in the popliteal region. The ulcerated scar was excised, and a superior gluteal artery perforator flap ( 20 × 9 cm ) was transferred to the defect. The vessels of the thinning flap were anastomosed to the medial sural vessels in an end-to-end fashion. The patient's postoperative course was uneventful.
Case 2 : The patient was a 43-year-old female. A split-thickness skin graft that was transferred after necrotizing fasciitis caused scar contracture of the knee. The contracture was released, and a superior gluteal artery perforator flap ( 15 × 8 cm ) was transferred to the defect. The graft's vessels were anastomosed to the medial sural vessels in an end-to-side fashion. Relocation of the flap was required due to congestion.
This procedure was performed by two teams working simultaneously, with the patient in the prone position. The diameters of the vessels used for the anastomoses were similar, and the length of the pedicle was adequate. Our experience indicates that this combined approach is a reasonable solution when it is difficult to use local flaps.
