Reconstruction of a surgical defect in the popliteal fossa: A case report

Highlights

• Popliteal tumors and their associated defects present the dermatologic surgeon with rare and unique surgical and reconstruction challenges.

• When planning reconstruction in the popliteal fossa, prolonged wound care and functional impairment are concerns.

• In such an area with little tissue laxity, a random patterned bilobed with an undersized secondary lobe is an excellent solution to this challenge.

Abstract

Introduction

Surgical defects of the popliteal fossa pose a reconstructive challenge to the surgeon, given the intimate relationship of this area with the knee joint and underlying vital neuro-vasculature.

Case presentation

An 88-year-old woman was treated for a biopsy proven invasive squamous cell carcinoma of the right popliteal fossa with Mohs micrographic surgery. The resultant defect (4.5 × 4.3 cm) was repaired using a random patterned bilobed flap with an undersized secondary lobe and porcine xenograft with excellent functional and cosmetic outcome.

Discussion

Numerous approaches to reconstruction of the popliteal fossa have been proposed, including primary closure, secondary intent healing, skin grafting, random flaps, muscle flaps, fasciocutaneous flaps, freeflaps, and tissue expansion. Sub-optimal repair of the popliteal fossa can reduce mobility of the knee joint, carry a high risk of wound dehiscence and may result in significant scarring. Here, we present the use of a bilobed flap with an undersized secondary lobe, in a patient with limited tissue laxity, for the repair of the popliteal fossa.

Conclusion

Utilizing a random pattern bilobed flap with an undersized secondary lobe is an excellent alternative for the repair of moderate sized popliteal fossa defects.