Free descending genicular artery perforator flap harvested with the free-style approach: a case report.

The descending genicular artery perforator flap, also known as the saphenous flap, has rarely been used as a free flap. We report the successful use of a free descending genicular artery perforator flap to reconstruct a defect of the medial calf region in a 13-year-old boy with Ewing sarcoma. A dominant perforator from the descending genicular artery was detected preoperatively with computed tomographic angiography and colour Doppler ultrasonography. This flap provides a perfect texture match to the medial calf region, and its donor-site scars are better hidden than those on the lateral thigh. We believe that this flap is a versatile 'free-style free flap' for patients in whom a sizable perforator can be found with preoperative imaging.