“Lymphatic vessels preserving descending genicular artery perforator (LpDGAP) flap for a skin defect on the anterior knee: A single case report”

Abstract

The medial thigh, rich in lymphatic vessels, presents risks of seroma and lymphoedema after flap elevation. This study discusses a novel approach using indocyanine green (ICG) to preserve lymphatic vessels while harvesting a descending genicular artery perforator (DGAP) flap for knee reconstruction. Here, we present the case of a 44-year-old woman who developed a skin defect below the right knee after cellulitis and abscess debridement. Preoperative ICG lymphography identified the lymphatic pathways, allowing for a meticulous flap design to avoid vessel damage. The surgery resulted in successful flap integration and a full range of knee motion without complications. Follow-up ICG lymphography confirmed the preservation of the lymphatic vessels. This case underscores the importance of lymphatic preservation in medial thigh flap procedures to minimise postoperative complications, such as seroma, cellulitis, and transient lymphoedema. Further research is required to explore the applications of this technique in broader clinical settings.