An 82-year-old female diabetic patient had skin necrosis measuring 30 mm×30 mm with partial patellar tendon exposure after retrograde intramedullary nailing for repair of a distal femoral fracture. Although debridement of the knee lesion was performed and followed by negative pressure wound therapy (NPWT) for two weeks, which facilitated granulation formation, partial necrosis of the patellar tendon remained. Thus, the skin defect was reconstructed using a pedicle fascial flap based on the veno-neuro-accompanying artery fascio-cutaneous (V-NAF) flap procedure. The adipofascial flap, containing the small saphenous vein, sural nerve and accompanying arteries, was lifted from the posterior aspect of the leg and transferred to the skin defect through a subcutaneous tunnel. Subsequently, a skin graft from the lower abdomen was transplanted onto the grafted adipofascial flap, and NPWT was applied for 5 days. Both the grafted adipofascial flap and skin survived. The patient was discharged from the hospital at 14 days postoperatively. Our treatment method may be effective for skin defects on the leg, even in elderly patients.
