title: Revisit of the anatomy of the distal perforator of the descending genicular artery and clinical application of its perforator "propeller" flap in the reconstruction of soft tissue defects around the knee.
abstract: OBJECTIVE
  In this article,we revisited the anatomy of the distal perforator of the descending genicular artery (DGA) and report the clinical application of its perforator propeller flap in the reconstruction of soft tissue defects around the knee.
  
  
  METHODS
  Forty fresh human lower limbs were dissected to redefine the anatomy of the branches of the DGA and their perforators and the anatomical landmarks for clinical applications. Five patients underwent "propeller" distal anteromedial thigh (AMT) flaps based on DGA perforators for the reconstruction of post-traumatic (n = 4) and post-oncologic (n = 1) soft tissue defects occurring near the knee with a size ranging from 4.8 cm × 6.2 cm to 10.5 cm × 18.2 cm.
  
  
  RESULTS
  A constant cutaneous perforator of the osteoarticular branch (OAB) of the DGA was found in the distal AMT fossa with a mean caliber of 1.2 ± 0.4 mm. It arose 9.4 ± 3.1 cm distally to the origin of the OAB and 4.0 ± 0.4 cm above the knee joint. The size of the harvested flaps ranged from 6.0 cm × 7.1 cm to 11.0 cm × 20.1 cm. All the flaps healed uneventfully at a mean period of 7.4 months. All the patients regained full range motion of the knee-joint.
  
  
  CONCLUSIONS
  Our study provided evidence of the vascular supply and the clinical application of the distal AMT flap based on a constant perforator arising from the OAB of the DGA. This flap may be a versatile alternative for the reconstruction of the defects around the knee because of its consistent vascular pedicle, pliability and thinness, adequate retrograde perfusion, and the possible direct suture of the donor site.
authors.affiliation: Clinical Anatomic Center, Fuzhou, General Hospital of People's Liberation Army, Nanjing District, Fuzhou, Fujian, China.
authors.forename: He-Ping
authors.initials: HP
authors.lastname: Zheng
authors.affiliation: Clinical Anatomic Center, Fuzhou, General Hospital of People's Liberation Army, Nanjing District, Fuzhou, Fujian, China.
authors.forename: Yue-Hong
authors.initials: YH
authors.lastname: Zhuang
authors.affiliation: Clinical Anatomic Center, Fuzhou, General Hospital of People's Liberation Army, Nanjing District, Fuzhou, Fujian, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Lin
authors.affiliation: Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
authors.forename: Yi Xin
authors.initials: YX
authors.lastname: Zhang
authors.affiliation: Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA.
authors.forename: L Scott
authors.initials: LS
authors.lastname: Levin
authors.affiliation: Department of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, University Hospital of Ancona, Ancona, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Grassetti
authors.affiliation: Plastic Reconstructive and Aesthetic Surgery Unit, Villa Salaria Clinic, Rome, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Lazzeri
authors.affiliation: Plastic and Reconstructive Surgery Unit, Campus Bio-Medico di Roma University, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Persichetti
mesh_terms: D000328:Adult; D001158:Arteries / Q000033:anatomy & histology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007717:Knee / Q000098:blood supply* / Q000601:surgery; D007718:Knee Injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061525:Perforator Flap / Q000098:blood supply*; D019651:Plastic Surgery Procedures / Q000379:methods*; D017695:Soft Tissue Injuries / Q000601:surgery*; D016896:Treatment Outcome