Superior Lateral Genicular Artery Perforator Flap for Reconstruction of Anterolateral Knee Soft Tissue Defects

BACKGROUND: Soft tissue defects around the knee remain a reconstructive challenge because of limited local tissue availability, exposure of vital structures, and the need to preserve joint function. Previous anatomical studies and small clinical reports have described the superior lateral genicular artery perforator (SLGAP) flap, but evidence guiding selection among propeller, bilobed, and keystone configurations remains limited. This report describes clinical outcomes in a retrospective series of predominantly anterior and lateral knee soft tissue defects and explores configuration selection in relation to defect size, geometry, and location. METHODS: A retrospective review was performed of consecutive patients who underwent reconstruction using an SLGAP flap between January 2017 and December 2025. Perforators were mapped preoperatively using handheld or color Doppler ultrasonography. According to defect size, geometry, location, and required flap mobility, the flaps were designed in propeller, bilobed, or keystone configurations. Flaps were elevated in the subfascial plane with preservation of the identified perforator, mobilized and transferred without excessive tension or pedicle compression, and inset after clinical confirmation of adequate perfusion. Patient demographics, defect characteristics, flap design, postoperative complications, flap survival, and clinical outcomes were analyzed. Ambulatory status was recorded from routine subjective clinical assessment; no standardized functional outcome instrument was used. RESULTS: Fifteen patients underwent reconstruction with an SLGAP flap. Mean defect dimensions were 6.9 × 5.7 cm (length range, 4-15 cm; width range, 3-10 cm), and defects were located in the anterior patellar (n = 9), lateral patellar (n = 5), and medial patellar (n = 1) regions. Mean flap dimensions were 14.7 × 7.0 cm (length range, 6-25 cm; width range, 5-10 cm); 10 propeller, four bilobed, and one keystone flap were used. Trauma was the most common etiology (n = 9), followed by electrical burns (n = 2), tumor resection (n = 2), radiation necrosis (n = 1), and prosthesis exposure (n = 1). Initial defect coverage was achieved in all patients, with no early total flap loss. Marginal necrosis occurred in two patients and transient venous congestion in one; these complications resolved without further reconstruction. One patient developed delayed total flap necrosis approximately 5-6 days after surgery and underwent secondary reconstruction with a lateral gastrocnemius muscle flap. Among the 13 patients with available follow-up data, mean follow-up was 17.4 months (range, 2-72 months). Stable wound coverage was maintained in 14 of 15 patients, with no major donor-site complications. All 15 patients were documented as ambulatory during postoperative care based on routine subjective clinical assessment; however, knee range of motion, gait, and functional status were not assessed using standardized instruments. CONCLUSIONS: In this retrospective series, SLGA perforator flaps were used to reconstruct predominantly anterior and lateral knee soft tissue defects in propeller, bilobed, and keystone configurations. Stable wound coverage at the latest available follow-up was observed in 14 of 15 patients, with no major donor-site complications. These findings suggest that adapting flap configuration to defect characteristics may be feasible in selected patients; however, the small sample, absence of a comparison group, variable follow-up, and lack of standardized functional outcomes preclude conclusions regarding superiority, broad reliability, or general applicability.