Distally based anteromedial thigh fasciocutaneous island flap for patellar soft tissue reconstruction.

Background: Muscles used for patellar and peripatellar soft tissue construction, which include the vastus medialis, vastus lateralis, gastrocnemius, and sartorius muscle, are often clinically inadequate for reconstruction of the patellar and peripatellar regions. Split-thickness skin grafts are also inadequate in supporting superficial patellar tendons and resisting perpetual shear stress. We report our experience with distally based anteromedial thigh fasciocutaneous island flaps for patellar soft tissue reconstruction in seven patients. Methods: Fasciocutaneous island flaps based on the cutaneous feeder vessels and perforator vessels in the muscle septum and deep fascia of the saphenous artery above the medial condylar of the femur were designed for seven patients. Transposition and rotation island flap designs were used. Results: Flap sizes ranged from 5 cm X 5 cm to 10 cm X 9 cm, and the mean size of the vascular pedicle was approximately 10 cm (range, 8-15 cm). All flaps survived completely, whereas only one patient had venous congestion. Conclusions: A distally based anteromedial fasciocutaneous flap is useful and viable option for patellar soft tissue reconstruction due to its versatile vascular pedicle, pliable deep fascia, adequate retrograde perfusion, and the possibility of direct closure of the donor site when no losses of the medial thigh are expected.