Potential of a Genicular Artery Perforator Keystone Flap for the Reconstruction of Defects in the Knee to the Upper Third of the Leg.

Abstract

The reconstruction of defects in the area extending from the knee to the upper third of the leg is challenging due to the intricate anatomy and limited local tissue options in this area. The genicular artery perforator keystone (GAP-K) flap is a promising solution for such reconstructions. In this study, the feasibility and outcomes of GAP-K flap use in the reconstruction of defects in the knee to upper third of the leg were assessed. Data on patients who underwent GAP-K flap reconstruction of defects in the knee to upper third of the leg in a single department between June 2021 and May 2023 were reviewed retrospectively. Patients' demographic characteristics, diagnoses, defect size, complications, and functional outcomes were analyzed. The sample comprised seven patients with a mean age of 44.9 years. Four GAP-K flaps were harvested from the medial aspect, and the remainder was harvested from the lateral aspect. Three flaps were type IIa, three were omega variants, and one was a Sydney Melanoma Unit variant. Mild wound dehiscence requiring management occurred in one patient. At 6 months postoperatively, the average range of motion of the affected knees was 126.7°, the average revised Musculoskeletal Tumor Society Rating Scale score was 25.5, and the average Eastern Cooperative Oncology Group performance status rating was 0.83. The GAP-K flap shows promise as a viable option for the reconstruction of defects in the knee to upper third of the leg. It provides reliable tissue coverage and satisfactory aesthetic outcomes. Further research with larger samples is warranted to confirm these findings and refine related surgical techniques.