Knee Extensor Mechanism Reconstruction Using a Free Tensor Fascia Lata Flap With Microsurgical Perforator-To-Perforator Anastomosis

Case: We present a 59-year-old male patient with recurrent right knee extensor mechanism deficiency who underwent reconstruction using a free vascularized tensor fascia lata flap from the ipsilateral thigh with submillimeter perforator-to-perforator anastomosis. Performed in a revisional setting (third surgery) with scarring and prior failure, novel aspects included dual-layer reinforcement and limited-incision harvest with tunneling. At 12 months, he regained full extension and a stable, pain-free gait. Conclusion: This case shows that a free vascularized tensor fascia lata flap with perforator-to-perforator anastomosis is a viable option for extensor mechanism reconstruction in complex, revisional cases.