1
|
Gupta R, Weisberger J, Herzog I, Roth J, Lee ES. Utilization of the gastrocnemius flap for post-traumatic knee reconstruction: a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-03938-2. [PMID: 38634884 DOI: 10.1007/s00590-024-03938-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE High-energy injuries to the knee may lead to extensive soft tissue loss, fractures, and potential loss of extensor function. The gastrocnemius flap is a prominent reconstructive option for patients with injuries involving the knee and proximal third of the lower extremity. To the best of our knowledge, there has not been an informative review that has evaluated outcomes of patients who have undergone post-traumatic knee reconstruction with a pedicled medial or lateral gastrocnemius flap. The goal of this study is to assess outcomes in patients who have undergone gastrocnemius flap reconstruction after traumatic injuries to the knee. METHODS The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) methodology. Four databases were utilized including PubMed, Cochrane Reviews, Embase, and CINAHL. Our search criteria consisted of the following keywords: gastrocnemius, flap, knee, and traum*. RESULTS A total of 204 studies were imported for screening, from which five papers met our final inclusion/exclusion criteria. The most common studies utilized in this review were case series followed by retrospective chart reviews. In total, 43 patients with traumatic soft tissue knee defects were included with an average patient age of 27.28 years. All patients had successful and clinical viable flaps post-operatively, and there were a total of five patients who had complications. CONCLUSION The gastrocnemius flap has demonstrated to be an effective option for individuals undergoing post-traumatic knee reconstruction. Infection rates, loss of mobility, and scarring represent a minority of complications that may be seen when this reconstructive technique is utilized. Still, additional randomized controlled trials and retrospective studies are required in order to further evaluate for other potential complications that may occur in this patient population.
Collapse
Affiliation(s)
- Rohun Gupta
- Oakland University William Beaumont School of Medicine Auburn Hills, Rochester, MI, USA
| | | | | | | | - Edward S Lee
- Department of Plastic Surgery, University Hospital, Newark, NJ, USA
| |
Collapse
|
2
|
Hamrouni N, Højvig JH, Knudsen UK, Skovgaard KK, Jensen LT, Bonde CT, Odgaard A. Microvascular free flap coverage of complex soft tissue defects after revision total knee arthroplasty: a cross-sectional observation study. Acta Orthop 2024; 95:186-191. [PMID: 38630868 PMCID: PMC11024721 DOI: 10.2340/17453674.2024.40183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 02/10/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND AND PURPOSE Soft tissue defects after total knee arthroplasties (TKA) represent a major orthopedic challenge with amputation as a feared outcome. Microvascular free flap coverage (FFC) can increase limb salvage rates, but complications related to the procedure are yet to be explored further. We aimed to review a single-center experience with FFC for soft tissue defects related to revision total knee arthroplasty. METHODS Through a retrospective chart review from 2006 to 2021, we identified all patients who had FFC of a knee with an existing TKA. Typically, patients underwent 2-stage revision arthroplasty. To identify areas of intervention, we divided the entire regimen into 2 phases divided by the free flap surgery (pre- and post-free flap). RESULTS We identified 18 patients with a median age at free flap surgery of 69 years (range 39-85), who were followed for a median of 5.1 years (range 2 months to 10.6 years). The median duration from primary TKA to their final operation was 17.5 months (range 19 days to 7 years). Patients underwent a mean of 7.6 surgical procedures on their knee with 3.6 orthopedic revisions prior to the FFC and 0.6 after. Soft tissue coverage was achieved in all patients and no patients underwent amputation. One-third of patients experienced early complications at recipient site after free flap surgery. There were no donor site complications. CONCLUSION Microvascular FFC of complex soft tissue defects after revision total knee arthroplasty proved achievable in all patients with successful limb salvage in all patients.
Collapse
Affiliation(s)
- Nizar Hamrouni
- Department of Plastic Surgery and Burns Treatment, Center of Head, Neck and Orthopedics, University Hospital of Copenhagen, Rigshospitalet, Copenhagen.
| | - Jens H Højvig
- Department of Plastic Surgery and Burns Treatment, Center of Head, Neck and Orthopedics, University Hospital of Copenhagen, Rigshospitalet, Copenhagen
| | - Ulrik K Knudsen
- Department of Orthopedic Surgery, Center of Head, Neck and Orthopedics, University Hospital of Copenhagen, Rigshospitalet, Copenhagen
| | - Kurt K Skovgaard
- Department of Orthopedic Surgery, Center of Head, Neck and Orthopedics, University Hospital of Copenhagen, Rigshospitalet, Copenhagen
| | - Lisa T Jensen
- Department of Plastic Surgery and Burns Treatment, Center of Head, Neck and Orthopedics, University Hospital of Copenhagen, Rigshospitalet, Copenhagen
| | - Christian T Bonde
- Department of Plastic Surgery and Burns Treatment, Center of Head, Neck and Orthopedics, University Hospital of Copenhagen, Rigshospitalet, Copenhagen
| | - Anders Odgaard
- Department of Orthopedic Surgery, Center of Head, Neck and Orthopedics, University Hospital of Copenhagen, Rigshospitalet, Copenhagen; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
3
|
Hecker A, Watzinger N, Pignet AL, Schellnegger M, Reinbacher P, Girsch W. Pedicled Rectus Femoris Flap for Restoration of Suprapatellar Quadriceps Tendon and Defect Coverage after Multiple Reconstruction Attempts-A Case Report and Literature Review. J Pers Med 2024; 14:136. [PMID: 38392570 PMCID: PMC10889967 DOI: 10.3390/jpm14020136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
There is no unified approach for restoring the suprapatellar quadriceps tendon and covering tissue defects simultaneously. In this case report, we present the pedicled myocutaneous rectus femoris flap as one effective approach in two cases with extensive loss or impairment of the suprapatellar muscle-tendon structures after trauma-related suprapatellar quadriceps tendon rupture and multiple reconstruction attempts. Additionally, we provide a literature review of the reconstructive use of the functional pedicled myocutaneous rectus femoris flap. METHODS Two male patients, 48 and 74 years old, with extensive loss or impairment of the suprapatellar muscle-tendon structures due to multiple reconstruction attempts, underwent restoration of the knee extension with a pedicled myocutaneous rectus femoris flap. RESULTS Three months after reconstruction, both patients were able to walk freely, unaided. After a six-month follow-up, the free passive mobility of the knee joint was restored, and the active extension of the knee joint was possible in both patients. CONCLUSION The authors conclude that the pedicled rectus femoris flap is a reliable method for the restoration of knee extension, with excellent functional results in cases of suprapatellar tendon lesions. Further to the functional restoration, this technique has the additional advantage of simultaneously achieving coverage of soft-tissue defects, while a direct closure of the donor site is possible. Elderly patients and patients with relevant comorbidities or multiple revisions may especially benefit from this technique.
Collapse
Affiliation(s)
- Andrzej Hecker
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/4, 8036 Graz, Austria
- COREMED-Center for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, Neue Stiftingtalstraße 2, 8010 Graz, Austria
| | - Nikolaus Watzinger
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/4, 8036 Graz, Austria
| | - Anna-Lisa Pignet
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/4, 8036 Graz, Austria
- COREMED-Center for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, Neue Stiftingtalstraße 2, 8010 Graz, Austria
| | - Marlies Schellnegger
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/4, 8036 Graz, Austria
| | - Patrick Reinbacher
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Werner Girsch
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/4, 8036 Graz, Austria
| |
Collapse
|
4
|
Cheng L, Du WL, Zhang Y, Chen Z, Shen YM. Application of Staged Negative Pressure Wound Therapy and Flap Surgery for Infection Control After Patellar Internal Fixation Surgery. J Craniofac Surg 2024; 35:e74-e78. [PMID: 37982783 DOI: 10.1097/scs.0000000000009854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/07/2023] [Indexed: 11/21/2023] Open
Abstract
The anatomic position of the patella is superficial, making it vulnerable to injuries. Treatment of patella infection after internal fixation surgery remains a big challenge due to minimal soft tissue coverage and vital tissue exposure. Forty-two patients aged 10 to 59 years were admitted to the institution's burn unit between January 2010 and December 2019. Each presented with infection after patellar fracture surgery. Twenty-seven infections were superficial, whereas 15 were deep with pyogenous arthritis of the knee. Negative pressure wound therapy (NPWT) was applied after radical debridement to remove necrotic subcutaneous tissues and internal fixation devices. In addition, cases with septic arthritis were irrigated continuously with normal saline. After 5 to 10 days of NPWT treatment and irrigation, wound infection was well controlled. Afterward, 42 wounds were resurfaced with pedicled flaps, the 42 patients received 17 reverse-flow anterolateral thigh (ALT) perforator flap, 12 medial sural artery perforator flaps, 7 gastrocnemius musculocutaneous flaps, as well as 6 saphenous artery flaps. Thirty-seven flaps survived uneventfully. However, 3 flaps developed venous congestion in the distal end. Two flaps developed tip necrosis. All patients were followed up between 3 and 48 months. Infection beneath the flap occurred in 3 patients and healed after an additional debridement surgery. The staged NPWT and flap surgery strategy focus on thorough debridement and immediate internal fixation devices removal, effective fracture fixation, efficient NPWT application, targeted administration of antibiotics, and adequate soft tissue coverage. This study established that the procedure was effective in infection control after patellar internal fixation surgery.
Collapse
Affiliation(s)
- Lin Cheng
- Department of Burns and Plastic Surgery, Beijing Jishuitan Hospital, Beijing, P.R. China
| | | | | | | | | |
Collapse
|
5
|
Alban A, Meroni M, Fuchs B, Scaglioni MF. Combined use of lower medial thigh perforator (LMTP) flap and pedicled medial sural artery perforator flap (MSAP) for lateral knee defects coverage after sarcoma resection: A case report and literature review of soft tissue defect around knee reconstruction. Microsurgery 2024; 44:e31125. [PMID: 37830398 DOI: 10.1002/micr.31125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/08/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
Reconstruction of knee defects still represents a challenge for reconstructive surgeons. After an extensive resection, the primary aim is to reach a stable result, while maintaining a good range of motion and aesthetic unity. The use of pedicled perforator-based flaps makes it possible to achieve these goals. Many are the flaps that can be used in this region, and the pedicle medial sural artery perforator (mSAP) flap is considered among one of the first-choice techniques. The purpose of this case report is to describe for the first time the use of pedicled mSAP flap to cover a lateral knee defect. A 79-year-old patient underwent extensive excision of sarcoma on the lateral side of the left knee, with removal of distal portion of the vastus lateralis muscle and portion of the biceps femoris tendon. The resulting defect from the excision measured 10 cm × 10 cm. To cover the postero-inferior part of the defect we decided to use a mSAP flap, with a skin paddle 10 cm × 5 cm, which was tunneled posteriorly to the popliteal artery and vein in order to reach the affected site. We then used a lower medial thigh perforator (pLMT) flap with a 15 cm × 5 cm skin paddle, rotated by 90° in a propeller fashion to cover the antero-superior portion of the defect. The decision to use two flaps was justified by the fact we wanted to close the donor areas with direct suturing for a better aesthetic result. The post-operative course was regular with only a small wound dehiscence that had healed by secondary intention. At 6 months postoperatively, the patient showed a complete active range of motion of the knee joint and absolute aesthetic satisfaction with flaps donor site and knee shape. A review of literature is also provided, with a specific focus on the different procedures for soft tissue defects reconstruction around the knee. According to our experience, the pedicle of the MSAP flap may be safely used as an additional reconstructive option for lateral knee defects.
Collapse
Affiliation(s)
- Alice Alban
- Depatment of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Matteo Meroni
- Depatment of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Bruno Fuchs
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Department of Orthopedic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Mario F Scaglioni
- Depatment of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| |
Collapse
|
6
|
Miyamae M, Urabe R, Nakai K. Usefulness of perforating branches of the deep femoral artery and vein as recipient vessels during free-flap reconstruction for extensive defects of the thigh. J Surg Case Rep 2023; 2023:rjad683. [PMID: 38163057 PMCID: PMC10755091 DOI: 10.1093/jscr/rjad683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 12/03/2023] [Indexed: 01/03/2024] Open
Abstract
The perforating branches of the deep femoral artery and vein are considered useful recipient vessels during free-flap reconstruction for extensive defects extending from the knee to the mid-thigh or from the lateral to the posterior region of the thigh. Despite being located deep between the adductor longus and magnus muscles, they can be easily identified, allowing for a sufficient surgical field for the vascular anastomosis. Approximately four perforators from the deep femoral artery can be found on the posterior aspect of the thigh, easily identified by dissecting the semitendinosus and biceps femoris muscles. The calibre and length of the perforators were suitable for vascular anastomosis. In this study, we present three cases of free-flap reconstruction for extensive thigh defects using perforating branches of the deep femoral artery and vein as recipient vessels.
Collapse
Affiliation(s)
- Makoto Miyamae
- Department of Plastic and Reconstructive Surgery, University of Fukui Hospital, 23-3, Matsuokashimoaizuki, Eiheiji-cho, Fukui 910-1193, Japan
| | - Ryotaro Urabe
- Department of Plastic and Reconstructive Surgery, University of Fukui Hospital, 23-3, Matsuokashimoaizuki, Eiheiji-cho, Fukui 910-1193, Japan
| | - Kunihiro Nakai
- Department of Plastic and Reconstructive Surgery, University of Fukui Hospital, 23-3, Matsuokashimoaizuki, Eiheiji-cho, Fukui 910-1193, Japan
| |
Collapse
|
7
|
Lee KI, Lin YN, Lin YC, Kuo YR. Healing of a bone-exposed soft tissue defect after surgical correction of traumatic patellar dislocation: A case report. Medicine (Baltimore) 2023; 102:e36324. [PMID: 38013271 PMCID: PMC10681570 DOI: 10.1097/md.0000000000036324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023] Open
Abstract
RATIONALE Reconstructive surgery is widely considered the primary treatment for soft tissue defects around the knee owing to its high flexibility. However, in our recent case study, we explored an alternative approach using decellularized collagen dressings, which proved highly effective in healing a soft tissue defect involving bone exposure following surgical correction of a traumatic patellar dislocation. PATIENT CONCERNS A 65-year-old male with a traumatic patellar dislocation in the lower extremity failed to approximate the wound after surgical correction. The patient refused additional surgical reconstruction because of the potential risks of multiple operative complications. DIAGNOSES Traumatic patellar dislocation complicated by exposed bone following surgical treatment was made. INTERVENTIONS The procedure was performed using ABCcolla® Collagen Matrix (ACRO Biomedical, Taiwan), an acellular dermal matrix made from a decellularized native porcine collagen scaffold dressing. Collagen dressings were applied to the soft tissue defect, and biointegration was observed in the wound area of bone exposure. OUTCOMES Through the application of ABCcolla® Collagen Matrix (ACRO Biomedical, Taiwan) and diligent wound care for a total of 105 days, the patient healed successfully and achieved partial functional recovery after undergoing rehabilitation. During recent outpatient clinic visits, the patient is now able to ambulate independently with the aid of crutches. LESSONS Collagen dressings circumvent the potential risks and complications associated with multiple surgical procedures. We believe that the utilization of collagen dressings, combined with careful wound management, could serve as a promising alternative treatment option for patients with soft tissue defects around the knee in the future.
Collapse
Affiliation(s)
- Kuan-I Lee
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yun-Nan Lin
- School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Chuan Lin
- Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yur-Ren Kuo
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
8
|
Ha Y, Lee BH, Park JA, Kim YH. Reconstruction of soft tissue defect around knee with thoracodorsal artery perforator flap and muscle-sparing latissimus dorsi flap. Microsurgery 2023; 43:665-675. [PMID: 36789684 DOI: 10.1002/micr.31024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 12/15/2022] [Accepted: 02/02/2023] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Around the knee reconstruction is challenging for reconstructive surgeons. Several methods have been proposed, including perforator and muscle flaps; however, all have advantages and disadvantages. As the success rate of free-flap surgery increases, reconstruction around the knee using this method is becoming increasingly popular. Nevertheless, there are no large-scale case reports in the previous literature using either a thoracodorsal artery perforator flap (latissimus dorsi (LD) perforator flap) or a muscle-sparing latissimus dorsi (msLD) flap for reconstruction around the knee. In this retrospective report, we describe our clinical experiences and present an algorithm regarding recipient vessel choice in free-flap reconstructive surgery of around the knee defects. PATIENT AND METHODS Fifty-six cases in which a flap from the lateral thoracic area was used to reconstruct an around the knee defect between January 2016 and March 2022 were reviewed. The patients were aged 18-87 years (mean, 52.13 years), and of the 56 patients, 36 were male and 20 were female. Injuries were caused by trauma, contracture, rheumatoid vasculitis, tumor, infection, burns, sunken deformity, and pressure sores. The 56 cases included 22 with a defect including the knee, 14 with a defect below the knee (7 of the primary below-knee amputation [BKA] and 7 of the secondary BKA), 9 involving the distal medial thigh, 8 involving the distal lateral thigh, 2 involving the popliteal area, and 1 involving the middle thigh. Most cases were reconstructed using a single LD perforator flap or msLD flap. Chimeric or supplementary flaps were used when extensive coverage or dead space obliteration was required. The average size of the defect area was 253.6 cm2 (range: 5 × 6-21 × 39 cm2 ). RESULTS In the cases, the recipient artery used included the following: descending genicular artery (23), superficial femoral artery (14), descending branch of the lateral circumflex femoral artery (14), anterior tibial artery (2), popliteal artery (2), and posterior tibial artery (1). The recipient vein included the greater saphenous vein (24), descending branch of the lateral circumflex femoral vein (14), superficial femoral vein (7), descending genicular vein (6), anterior tibial vein (2), popliteal vein (2), and posterior tibial vein (1). The average flap size was 281.8 cm2 (range: 4 × 8-35 × 19 cm2 ). All flaps survived; however, seven complications occurred, including 2 partial flap losses, 1 arterial insufficiency, 1 hematoma, 1 minor dehiscence, 1 donor-site graft loss, and 1 short BKA. Normal knee range of motion (121-140°) was observed in 34 patients and 16 showed varying degrees of limited range of motion. Motion was not observed in four patients who underwent knee fusion and could not be evaluated in two patients who underwent above-knee amputation. The mean follow-up duration was 24.6 months (range: 4-72 months). CONCLUSION The LD perforator flap is ideal for the reconstruction of around the knee defects because it enables a long pedicle, large flap, and chimeric design. The msLD flap is ideal because it enables strong stump support, dead-space obliteration, and infection control. Moreover, since the two flaps are distant from the knee, this method is advantageous in terms of postoperative rehabilitation and there is minimal donor-site morbidity due to the thin nature of the LD muscle. In addition, the flap can be elevated in three positions and the operation can be completed without positional changes in various recipient vessel locations. Based on our experience, we conclude that the LD flap has the potential to be used as widely as or in preference to the anterolateral thigh flap in the reconstruction of around the knee defects.
Collapse
Affiliation(s)
- Yooseok Ha
- Department of Plastic and Reconstructive Surgery, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Bo Hyun Lee
- Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Ji Ah Park
- Design Lab of Technology Commercialization Center, Industry-University Cooperation, Foundation of Hanyang University, Seoul, Republic of Korea
| | - Youn Hwan Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| |
Collapse
|
9
|
Green CC, Stelzer JW, Kerr MS, Tang A, Menken LG, Romanelli F, Miller JM, Liporace FA, Haidukewych GJ, Yoon RS. Risk Factors for Revision Surgery Following Revision Total Knee Arthroplasty Using a Hinged Knee Prosthesis for Septic and Aseptic Indications. J Am Acad Orthop Surg 2023; 31:e798-e814. [PMID: 37235694 DOI: 10.5435/jaaos-d-22-00746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION The use of hinged knee replacements (HKRs) for limb salvage is a popular option for revision total knee arthroplasty (RTKA). Although recent literature focuses on the outcomes of HKR for septic and aseptic RTKAs, little is reported on the risk factors of returning to the operating room. The purpose of this study was to evaluate risk factors of revision surgery and revision after receiving HKR for septic versus aseptic etiology. METHODS A multicenter, retrospective review was conducted on consecutive patients who received HKR from January 2010 to February 2020 with a minimum follow-up of 2 years. Patients were separated into two groups: septic and aseptic RTKAs. Demographic, comorbidity, perioperative, postoperative, and survivorship data were collected and compared between groups. Cox hazard regression was used to identify risk factors associated with revision surgery and revision. RESULTS One-hundred fifty patients were included. Eighty-five patients received HKR because of prior infection, and 65 received HKR for aseptic revision. A larger proportion of septic RTKA returned to the OR versus aseptic RTKA (46% vs 25%, P = 0.01). Survival curves revealed superior revision surgery-free survival favoring the aseptic group ( P = 0.002). Regression analysis revealed that HKR with concomitant flap reconstruction was associated with a three-fold increased risk of revision surgery ( P < 0.0001). DISCUSSION HKR implantation for aseptic revision is more reliable with a lower revision surgery rate. Concomitant flap reconstruction increased the risk of revision surgery, regardless of indication for RTKA using HKR. Although surgeons must educate patients about these risk factors, HKR remains a successful treatment option for RTKA when indicated. LEVEL OF EVIDENCE prognostic, level III evidence.
Collapse
Affiliation(s)
- Cody C Green
- From the Department of Orthopaedic Surgery, Division of Orthopaedic Trauma and Adult Reconstruction, Orlando Regional Medical Center, Orlando, FL (Dr. Green, Dr. Kerr, and Dr. Haidukewych); Department of Orthopaedic Surgery, Division of Orthopaedic Trauma and Adult Reconstruction, Jersey City Medical Center, Jersey City, NJ (Dr. Tang, Dr. Menken, Dr. Romanelli, Dr. Miller, Dr. Liporace, and Dr. Yoon); and Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT (Dr. Stelzer)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Hsieh YH, Kalmin D, Motoroko MI, Morsi M, Morsi A. Reconstructing complex peripatellar defects using the descending genicular artery perforator flap. ANZ J Surg 2023; 93:1950-1956. [PMID: 37334914 DOI: 10.1111/ans.18560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/21/2023] [Accepted: 05/28/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Complex peripatellar defects are commonly reconstructed with free flaps or pedicled muscle flaps, whereas pedicled fasciocutaneous perforator flaps are commonly overlooked. The descending genicular artery perforator (DGAP) flap is a versatile flap that offers thin and pliable tissue that provides ideal 'like with like' peripatellar soft tissue defect reconstruction. This paper aims to demonstrate the safe use of a pedicled fasciocutaneous DGAP flap for extensive traumatic peripatellar defect reconstructions and to exhibit the surgical pearls via a case series. METHODS A retrospective cohort study of consecutive complex peripatellar reconstructions with DGAP flaps was conducted from January 2011 to December 2018. Patient demographics, medical comorbidities, aetiology/size/and location of the defects were reviewed. Flap, donor site, and overall surgical outcomes were clinically assessed and documented. Descriptive statistics were conducted and analysed by IBM SPSS Statistics 23. RESULTS Five consecutive cases with complex peripatellar defects (5 × 8 to 8 × 10 cm) were recruited. Two were males, and three were females, with a mean age of 38.4 years. Four were trauma, and one was an oncological case. Descending genicular artery (DGA) perforators and DGA terminal branches were consistent. One patient needed a split-thickness skin graft to reconstruct the secondary defects. All the flaps survived with an average follow-up of 24 months. CONCLUSION The DGAP flap provides a reliable alternative to free flap for the large, complex peripatellar defect. With the inclusion of the proximal long saphenous vein and judicious selection of DGA perforators and its terminal branches, the DGAP flap can be harvested and used safely in the high-velocity impacted knee.
Collapse
Affiliation(s)
- Yun-Huan Hsieh
- Department of Plastic and Reconstructive Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Doran Kalmin
- Department of Plastic and Reconstructive Surgery, Western Health, Melbourne, Victoria, Australia
| | - Maitumelo Imeldah Motoroko
- Department of Plastic and Reconstructive Surgery, Western Health, Melbourne, Victoria, Australia
- Department of Plastic and Reconstructive Surgery, Alfred Health, Melbourne, Victoria, Australia
| | - Mohammed Morsi
- Department of Plastic and Reconstructive Surgery, Monash Health, Melbourne, Victoria, Australia
- Department of Plastic and Reconstructive Surgery, Alfred Health, Melbourne, Victoria, Australia
| | - Adel Morsi
- Department of Plastic and Reconstructive Surgery, Monash Health, Melbourne, Victoria, Australia
- Department of Plastic and Reconstructive Surgery, Western Health, Melbourne, Victoria, Australia
- Department of Plastic and Reconstructive Surgery, Alfred Health, Melbourne, Victoria, Australia
| |
Collapse
|
11
|
Kwon H, Lee S, Kim S, Song SH, Oh SH, Kim JH, Kyung H, Yang HJ, Ha Y. Reconstruction of complex knee wounds with a distally based gracilis flap and gastrocnemius myocutaneous flap: A case report. Front Surg 2023; 10:1109936. [PMID: 36843998 PMCID: PMC9952235 DOI: 10.3389/fsurg.2023.1109936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/16/2023] [Indexed: 02/10/2023] Open
Abstract
A gastrocnemius muscle flap is a versatile option for covering the proximal one-third of the lower leg and around the knee. On the other hand, it is of limited use in patients with short gastrocnemius muscle or insufficient volume. The authors present a case in which a knee soft tissue defect occurred in a very thin patient and was reconstructed using a gastrocnemius myocutaneous flap and a distally based gracilis flap as a supplementary flap.
Collapse
Affiliation(s)
- Hyeokjae Kwon
- Department of Plastic and Reconstructive Surgery, Chungnam National University Hospital, Daejeon, South Korea,Department of Plastic and Reconstructive Surgery, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Seokui Lee
- Department of Plastic and Reconstructive Surgery, Chungnam National University Hospital, Daejeon, South Korea
| | - Sunje Kim
- Department of Plastic and Reconstructive Surgery, Chungnam National University Hospital, Daejeon, South Korea
| | - Seung Han Song
- Department of Plastic and Reconstructive Surgery, Chungnam National University Hospital, Daejeon, South Korea,Department of Plastic and Reconstructive Surgery, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Sang-Ha Oh
- Department of Plastic and Reconstructive Surgery, Chungnam National University Hospital, Daejeon, South Korea,Department of Plastic and Reconstructive Surgery, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Joo-hak Kim
- Department of Plastic and Reconstructive Surgery, Chungnam National University Sejong Hospital, Sejong, South Korea
| | - Hyunwoo Kyung
- Department of Plastic and Reconstructive Surgery, College of Medicine, Chungnam National University, Daejeon, South Korea,Department of Plastic and Reconstructive Surgery, Chungnam National University Sejong Hospital, Sejong, South Korea
| | - Ho Jik Yang
- Department of Plastic and Reconstructive Surgery, Chungnam National University Sejong Hospital, Sejong, South Korea
| | - Yooseok Ha
- Department of Plastic and Reconstructive Surgery, Chungnam National University Hospital, Daejeon, South Korea,Department of Plastic and Reconstructive Surgery, College of Medicine, Chungnam National University, Daejeon, South Korea,Correspondence: Yooseok Ha
| |
Collapse
|
12
|
Jeong SH, Baik SH, Namgoong S, Dhong ES, Han SK. An algorithmic approach to soft-tissue reconstruction around the knee using anterolateral thigh perforator flap in patients with post-traumatic knee osteomyelitis. Front Surg 2023; 10:982669. [PMID: 36814861 PMCID: PMC9939455 DOI: 10.3389/fsurg.2023.982669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/03/2023] [Indexed: 02/08/2023] Open
Abstract
Background Free tissue transfer to the knee region in patients with chronic post-traumatic knee osteomyelitis (CTKOM) poses a great challenge to surgeons because the remaining soft tissues adjacent to defects, including vascular structures, are usually damaged by chronic inflammation and multiple debridements. Thus, we developed an algorithm to help select the optimal recipient vessels and appropriate anterolateral thigh perforator (ALTP) flap type. In addition, we performed surgery using this algorithm and achieved successful reconstructions. This study aims to review our experiences in algorithmic reconstruction and assess its efficacy. Methods According to the defect size and location, our algorithm suggested the use of various-shaped ALTP flaps with centrally located perforators (Cen-ALTP flap) or eccentrically located perforators (Ecc-ALTP flap). Besides, through the algorithm, one recipient vessel was selected among three candidates, including descending branch of the lateral circumflex femoral artery (DB-LCFA), anterior tibial artery (ATA), and posterior tibial artery (PTA). Based on this algorithmic decision, we performed individualized soft tissue reconstructions of the knee in 21 patients with CTKOM, between March 2013 and June 2021. The medical records of the patients were retrospectively reviewed. Results The Cen-ALTP flap (n = 15) and ATA (n = 9) were the most commonly used for reconstruction. The Cen-ALTP flap anastomosed to the ATA was most commonly selected (n = 7) using the algorithm, followed by the Cen-ALTP flap anastomosed to the DB-LCFA (n = 5), and the Cen-ALTP flap anastomosed to the PTA (n = 3). All transferred ALTP flaps survived the follow-up period. Postoperative venous congestion in two patients and hematoma in one patient were resolved by immediate treatment. The postoperative course was uneventful. Conclusion During free ALTP flap transfer to CTKOM-related knee defects, we could select the optimal recipient vessel and appropriate flap type using our algorithm and obtain excellent reconstructive outcomes. Therefore, we believe that our algorithm could provide helpful guidance to reconstructive surgeons on free ALTP flap transfer to reconstruct CTKOM-related soft tissue defects.
Collapse
|
13
|
Chandra AA, Romanelli F, Tang A, Menken L, Zhang M, Feintisch A, Liporace FA, Yoon RS. A comparison of healing and complication rates between common flaps utilized in total knee arthroplasty: a review of the literature. Knee Surg Relat Res 2022; 34:15. [PMID: 35346398 PMCID: PMC8961959 DOI: 10.1186/s43019-022-00145-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/11/2022] [Indexed: 11/12/2022] Open
Abstract
Background Flap reconstruction with perforator, fasciocutaneous, muscular, and/or free microvascular flaps is utilized to cover wound defects and improve vascularization and antibiotic/nutrient delivery. Flap use in revision procedures for total knee arthroplasty has been explored previously; however, current data are limited and studies comparing healing and complication rates between different flap types are lacking. Methods A literature review was performed using PubMed on 13 January 2022. Studies were included if they reported healing and complication rates for either gastrocnemius, rectus abdominis, latissimus dorsi, fasciocutaneous, chimeric, or gracilis flaps in the setting of revision total knee arthroplasty (TKA). Results The final cohort included gastrocnemius (n = 421, healing rate 73.8%, complication rate 59.9%), gracilis (n = 9, healing rate 93%, complication rate 55.6%), latissimus dorsi (n = 41, healing rate 67%, complication rate 46.3%), rectus abdominis (n = 3, healing rate 100%, complication rate 0%), fasciocutaneous (n = 78, healing rate 70%, complication rate 19.2%), and chimeric flaps (n = 4, healing rate 100%, complication rate 25%). There was no significant difference when comparing healing rates across flap types (p = 0.39). There was a significant difference when comparing complication rates across flap types (p < 0.0001), with a significant difference being noted between gastrocnemius and fasciocutaneous complication rates (p < 0.0001). All other comparisons between flap types by complication rate were not significantly different. Conclusions Gastrocnemius flaps are the workhorse flap in the setting of revision TKA, as evidenced by this review. Healing rates did not vary significantly across flap types, which suggests that determining the appropriate flap for coverage of soft-tissue defects in revision TKA should be driven by defect size and location as well as physician experience and patient tolerance.
Collapse
|
14
|
Altramsy A, Dahy AA, Abu-Elsoud A, Khattab RF, Nafeh AM, Mohamed ANH, Saleh AK, Mahmoud BA. Saphenous Artery-based Posteromedial Leg Fasciocutaneous Flap for Knee Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4575. [PMID: 36299823 PMCID: PMC9592361 DOI: 10.1097/gox.0000000000004575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 08/16/2022] [Indexed: 06/16/2023]
Abstract
UNLABELLED Soft tissue knee defects are frequently seen in surgical practice. The saphenous artery (SA)-based flap is a management option with variable suggested donor sites. The present study describes the use of an SA-based flap harvested from the posteromedial aspect of the leg in management of soft tissue knee defects. METHODS The present study recruited 30 patients with soft tissue knee defects due to miscellaneous causes. All patients were treated with an SA-based flap harvested from the posteromedial aspect of the leg. All patients were followed up for 6 months. Outcome parameters included flap survival, flap complications, and restoration of knee function. RESULTS After 6 months of follow-up, all flaps survived; the reported complications were distal flap necrosis (6.7%), wound dehiscence (6.7%), seroma (3.3%), and small contracture band (3.3%). All patients restored normal range of motion around the knee. CONCLUSION An SA-based flap harvested from the posteromedial aspect of the leg is a feasible, safe, and effective option for management of soft tissue knee defects.
Collapse
Affiliation(s)
- Ayman Altramsy
- From the Department of Plastic Surgery, Al-Azhar University, Cairo, Egypt
| | - Asmaa A. Dahy
- From the Department of Plastic Surgery, Al-Azhar University, Cairo, Egypt
| | - Ahmed Abu-Elsoud
- From the Department of Plastic Surgery, Al-Azhar University, Cairo, Egypt
| | - Rania F. Khattab
- From the Department of Plastic Surgery, Al-Azhar University, Cairo, Egypt
| | - Ahmed M. Nafeh
- Department of Plastic Surgery, Helwan University, Cairo, Egypt
| | | | - Ayman K. Saleh
- Department of Surgery, College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Department of Orthopedic surgery, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | | |
Collapse
|
15
|
Bøkset MI, Söderman M, Thomsen JB, Sørensen JA. Reconstruction of a knee defect in a morbidly obese patient with a pedicled reverse anterolateral thigh flap. BMJ Case Rep 2022; 15:e249365. [PMID: 35858737 PMCID: PMC9305823 DOI: 10.1136/bcr-2022-249365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The anterolateral thigh (ALT) flap is widely used in the reconstruction of a variety of soft tissue defects. Descriptions of patients with severe obesity in the literature are scarce. We report a case where a reverse pedicled fasciocutaneous ALT flap was successfully used for resurfacing of a knee defect measuring 12×6 cm in a patient with a body mass index (BMI) of 47.3. The flap was supercharged to the greater saphenous vein to optimise flap survival. Reconstruction of the soft tissue of the knee was achieved as planned. There were no flap or donor site complications.
Collapse
Affiliation(s)
- Mari Irgens Bøkset
- Department of Plastic and Reconstructive Surgery, Odense University Hospital, Odense, Syddanmark, Denmark
| | - Martin Söderman
- Department of Plastic and Reconstructive Surgery, Odense University Hospital, Odense, Syddanmark, Denmark
| | - Jørn Bo Thomsen
- Department of Plastic and Reconstructive Surgery, Odense University Hospital, Odense, Syddanmark, Denmark
| | - Jens Ahm Sørensen
- Department of Plastic and Reconstructive Surgery, Odense University Hospital, Odense, Syddanmark, Denmark
| |
Collapse
|
16
|
CAI YC, ZHANG GY, LIAN J, SHI WJ, CAI YQ, FENG QY, ZHU L. Pre-expanded Muscle-Sparing Latissimus Dorsi Free Flap: An Ideal Option for the Reconstruction of Extensive Anterior Knee Contractures. J Plast Reconstr Aesthet Surg 2022; 75:3743-3750. [DOI: 10.1016/j.bjps.2022.06.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 05/19/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022]
|
17
|
Boucher F, Abihannah M, Chauvel-Picard J, Mojallal AA, Rouviere O, Brosset S. "Reverse tensor fascia latae perforator flap for reconstruction of knee defect: Anatomic study by computed tomographic angiography and a case report". Microsurgery 2022; 42:593-602. [PMID: 35338520 DOI: 10.1002/micr.30880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 01/03/2022] [Accepted: 02/24/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Reverse anterolateral thigh perforator (ALTp) pedicle flap can be used to reconstruct perigenicular defect thanks to the anastomoses between the descending branch of the lateral circumflex femoral artery (LCFA) and the perigenicular network. In a few cases, however, patients do not present any ALTp. We hypothesized that, in such cases, an adjacent perforator, the tensor fascia latae perforator (TFLp), emerging from the LCFA ascending branch, could be used instead. To assess the feasibility of this technique, a radiological study was conducted. A first patient was treated using this option. METHODS Sixty lower limb computed tomography were analyzed. The first treated patient was a 50-years-old man suffering from a 5-mm chronic bone exposure and osteomyelitis. Other reconstructive options were not indicated since he presented a multiscarry leg, severe arteriopathy, and no ALTp. A TFLp flap was raised, and the LCFA ascending and descending branches were dissected in continuity. After ligation of the LCFA, the blood flow reversed in the descending branch to irrigate the flap through the ascending branch. RESULTS A TFL perforator was observed in all the cases of the radiological study. The LCFA branching pattern was compatible with achieving a reverse TFL perforator flap in 43 cases (72%). The average pedicle length was 32 cm (22-38 cm). In the first clinical case, the flap covered the defect easily. After three months, the patient showed no evidence of infection recurrence and recovered a painless walk. CONCLUSION The reverse TFLp flap can be a suitable option for perigenicular reconstruction.
Collapse
Affiliation(s)
- Fabien Boucher
- Department of Plastic and Reconstructive Surgery, Croix Rousse Hospital, Hospices Civils de Lyon, University Claude Bernard Lyon, Lyon, France
| | - Michel Abihannah
- Department of Radiology Edouard Herriot Hospital, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France
| | - Julie Chauvel-Picard
- Department of Maxillofacial Surgery, Croix Rousse Hospital, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France
| | - Ali A Mojallal
- Department of Plastic and Reconstructive Surgery, Croix Rousse Hospital, Hospices Civils de Lyon, University Claude Bernard Lyon, Lyon, France
| | - Olivier Rouviere
- Department of Radiology Edouard Herriot Hospital, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France
| | - Sophie Brosset
- Department of Plastic and Reconstructive Surgery, Croix Rousse Hospital, Hospices Civils de Lyon, University Claude Bernard Lyon, Lyon, France
| |
Collapse
|
18
|
Lara Y, Aguilera-Sáez J, Tomás-Hernández J, Teixidor-Serra J, Khoudeir-Ávila AS, Andrés-Peiró JV. Treatment of a post-traumatic stiff knee after an open extensor apparatus injury by arthroscopic arthrolysis through a free flap. Trauma Case Rep 2021; 36:100553. [PMID: 34825042 PMCID: PMC8605279 DOI: 10.1016/j.tcr.2021.100553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 12/05/2022] Open
Abstract
Open patella fractures have high complication rates. Post-traumatic joint stiffness is particularly common. The management of this complication is even more difficult if free flap was used to cover a soft tissue defect. Late surgical manipulation of free flaps can lead to their failure, with catastrophic consequences. The use of minimally invasive techniques could reduce the associated risks. We present a case of knee stiffness after the fix and flap treatment of a grade IIIB open patella fracture. We performed an arthroscopic arthrolysis with portals through the flap. The pedicle was preoperatively located and avoided. Joint range of motion remarkably improved without records of flap complications. We consider that the technique is feasible. Its success was based on the multidisciplinary collaboration between orthopaedic and plastic surgeons and rehabilitation medicine specialists.
Collapse
Affiliation(s)
- Yuri Lara
- Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi Aguilera-Sáez
- Plastic Surgery Department and Burn Center, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi Tomás-Hernández
- Orthopaedic Trauma Unit, Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi Teixidor-Serra
- Orthopaedic Trauma Unit, Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - José-Vicente Andrés-Peiró
- Orthopaedic Trauma Unit, Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| |
Collapse
|
19
|
Manohar N, Vathulya M, Mahakalkar S. A Novel Fasciocutaneous Flap Design for Reconstructions in Scarred Tissue: A Case Report. Cureus 2021; 13:e16402. [PMID: 34401211 PMCID: PMC8364296 DOI: 10.7759/cureus.16402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 11/05/2022] Open
Abstract
This article aims to introduce a technically easy and reliable flap design for the coverage of soft tissue defects in areas where traditional flap options are limited by trauma or scarring. We applied the boomerang design in cases with defects around the knee and also extrapolated it to other regions like the wrist and sacrum. Patients with soft tissue defects in regions with scarred tissues or limited flap reconstructive options were recruited. The procedures resulted in uneventful recovery and excellent cosmetic outcomes for the patients. The authors of this article recommend the usage of this uncomplicated flap design in areas with otherwise limited flap options due to restricted vascularity or surrounding scar tissue.
Collapse
Affiliation(s)
- Nishank Manohar
- Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Madhubari Vathulya
- Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Sameer Mahakalkar
- Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| |
Collapse
|
20
|
Liu WC, Chang CH, Lu CC, Fu YC, Lu CK. Reconstruction of massive knee defects with extensor mechanism deficiency through concurrent anterolateral thigh flap and autogenous hamstring tendon: A report of two cases. J Orthop Surg (Hong Kong) 2021; 28:2309499020935994. [PMID: 32730729 DOI: 10.1177/2309499020935994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Reconstruction of an infected knee joint with a large defect and extensor mechanism deficiency is challenging. In this study, we aim to describe a one-stage reconstruction surgery and provide its surgical outcome. Two patients had patellar open fracture and subsequent septic arthritis; in addition, a large soft tissue defect, loss of patella, and shortening of the patellar tendon were observed. The semitendinosus-gracilis tendon formed a loop to stabilize the patella. A free or supercharged reverse pedicle myocutaneous anterolateral thigh flap with fascial extension is designed to fill the defect and eradicate the infection. Mean clinical follow-up was 18 months. Although some limitation in the knee range of motion was observed, the dynamometer showed only partial loss in peak concentric power and eccentric power. We developed an innovative surgical procedure to alleviate infection and reconstruct a complex knee defect with extensor mechanism deficiency; this procedure resulted in favorable clinical outcomes.
Collapse
Affiliation(s)
- Wen-Chih Liu
- Division of Orthopedic Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung.,Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung
| | - Chih-Hau Chang
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung
| | - Cheng-Chang Lu
- Division of Orthopedic Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung.,Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung.,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Yin-Chih Fu
- Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung.,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Chun-Kuan Lu
- Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung
| |
Collapse
|
21
|
Feng B, Li Z, Feng C, Zeng A, Gao P, Liu Y, Weng X. Early wound complications after orthopaedic surgery for haemophilia: What can we do more. Haemophilia 2020; 26:882-890. [PMID: 32741019 DOI: 10.1111/hae.14113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/08/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND The characteristics of the haemophilia may endanger the patient with haemophilia (PWH) to higher ratio of wound complication, even lead to the refractory wound problem. The early wound complication in PWH has not been well studied in literature. METHODS Between the period from 2002 to 2018, 250 patients underwent 323 elective orthopaedic surgical procedures for the treatment of haemophilic musculoskeletal disorders. The medical records were retrospectively reviewed. The patients were evaluated for postoperative wound complications within 30 days. Risk factors related to wound complications were further analysed. The patients underwent vacuum sealing drainage (VSD) for refractory wound healing problem were further analysed. RESULTS Twenty-four patients of 250 patients experienced early wound complication within postoperative 30 days. The incidence of wound complication in the patients without preoperative infection was 6.5%. Positive inhibitor and surgery for pseudotumour were associated with higher rate of wound complication after logistic regression, with the odds ratios (OR) of 5.7 (95% CI, 1.08 to 30.3) and 4.9 (95% CI, 1.3 to 18.5), respectively. Eight patients underwent VSD treatment for refractory wound healing problem and recovered uneventfully. The total VSD treatment cycle was 2.25 (from 2 to 4). The average factor consumption was 26.1 IU kg-1 d-1 . The patients complicated with infection had higher, but not statistically significantly, treatment duration, factor consumption and peri-VSD total blood loss than the patients without infection. CONCLUSIONS PWH had an incidence of 6.5% of early wound healing problem after elective orthopaedic surgery for musculoskeletal disorder in the present study. The presence of positive inhibitor and surgical procedure for haemophiliac pseudotumour are associated with higher incidence of wound healing problem. The VSD is an effective alternative for the treatment of refractory wound healing problem for PWH, especially for the patients complicated with infection.
Collapse
Affiliation(s)
- Bin Feng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Zeng Li
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China.,Division of Joint Osteopathy and Traumatology, Center of Orthopedics Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Cheng Feng
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Ang Zeng
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Peng Gao
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Yong Liu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Xisheng Weng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| |
Collapse
|
22
|
Soft tissue coverage options around the knee. ANN CHIR PLAST ESTH 2020; 65:517-523. [PMID: 32718770 DOI: 10.1016/j.anplas.2020.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 07/01/2020] [Indexed: 11/21/2022]
Abstract
Defects around the knee exhibit various etiologies and pose challenges to both orthopedists and plastic surgeons. While a number of reconstructive coverage options are available, flaps are almost always required for complex defects. Many local flaps are easily placed, including muscle and perforator flaps sourced from the thigh to the leg. As the recipient vessels lie deep, free tissue transfers are challenging. Good postoperative management and efficient collaboration between orthopedic and reconstructive surgeons are the keys to successful knee reconstruction, restoring an esthetic contour and preserving joint function.
Collapse
|
23
|
Martic K, Vukic M, Matic S. Single-stage quadriceps tendon reconstruction with gastrocnemius fascia and knee soft tissue defect reconstruction with medial gastrocnemius flap-A case report. Int J Surg Case Rep 2020; 72:620-623. [PMID: 32698302 PMCID: PMC7334542 DOI: 10.1016/j.ijscr.2020.06.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/17/2020] [Accepted: 06/05/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Quadriceps tendon rupture, although uncommon, is associated with knee joint instability and requires surgical repair. A variety of methods including allografts, synthetic grafts and autologous tendons are used for tendon reconstruction. This work is reported in line with the SCARE criteria (Agha et al., 2018) for case report publication. PRESENTATION OF CASE A new method of simultaneous quadriceps tendon reconstruction and soft tissue knee reconstruction in a 38-year-old male patient following trauma to his knee and subsequent multiple surgeries and wound infections. In a single-stage procedure, gastrocnemius muscle fascia was used for quadriceps tendon reconstruction and medial head of the gastrocnemius muscle flap with split-thickness skin graft was used to cover the soft tissue defect on the anterior aspect of the knee following previous post-operative soft tissue infections and subsequent skin necrosis. DISCUSSION The only way to maintain the vitality of the patella was to reconstruct the defect with well-vascularized tissue so we decided to use the medial gastrocnemius muscle flap. To obtain good quality tissue for the quadriceps tendon reconstruction, we decided to use the gastrocnemius muscle fascia to minimise the morbidity of the donor region and to reduce the duration of surgery. CONCLUSION Postoperatively, the patient had an excellent cosmetic outcome with full active extension and limited flexion of the knee joint caused by the preoperative condition. To our knowledge, quadriceps tendon reconstruction using the gastrocnemius muscle fascia has never been reported in English literature and is as valuable as already known reconstruction methods using other tendons or fascia.
Collapse
Affiliation(s)
- Kresimir Martic
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital "Dubrava", Avenija Gojka Suska 6, Zagreb, Croatia; University of Zagreb, School of Medicine, Department of Surgery, Salata 3, Zagreb, Croatia
| | - Mladen Vukic
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital "Dubrava", Avenija Gojka Suska 6, Zagreb, Croatia
| | - Stipo Matic
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital "Dubrava", Avenija Gojka Suska 6, Zagreb, Croatia.
| |
Collapse
|
24
|
Lee GC, Colen DL, Levin LS, Kovach SJ. Microvascular free flap coverage for salvage of the infected total knee arthroplasty. Bone Joint J 2020; 102-B:176-180. [DOI: 10.1302/0301-620x.102b6.bjj-2019-1661.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The integrity of the soft tissue envelope is crucial for successful treatment of infected total knee arthroplasty (TKA). The purpose of this study was to evaluate the rate of limb salvage, infection control, and clinical function following microvascular free flap coverage for salvage of the infected TKA. Methods We retrospectively reviewed 23 microvascular free tissue transfers for management of soft tissue defects in infected TKA. There were 16 men and seven women with a mean age of 61.2 years (39 to 81). The median number of procedures performed prior to soft tissue coverage was five (2 to 9) and all patients had failed at least one two-stage reimplantation procedure. Clinical outcomes were measured using the Knee Society Scoring system for pain and function. Results In all, one patient was lost to follow-up prior to 12 months. The remaining 22 patients were followed for a mean of 46 months (12 to 92). At latest follow-up, four patients (18%) had undergone amputation for failure of treatment and persistent infection. For the other 18 patients, 11 patients (50%) had maintained a knee prosthesis in place while seven patients had undergone resections for persistent infection but retained their limbs (32%). Reoperations were common following coverage and reimplantation. The median number of additional procedures was two (0 to 6). Clinical function was poor in patients who underwent reimplantation and retained a knee prosthesis following free flap coverage with a mean KSS score for pain and function of 44 (0 to 70) and 30 (0 to 65), respectively. All patients required an assistive device. Extensor mechanism problems and extensor lag requiring bracing were common following limb salvage and prosthesis reimplantation. Conclusion Microvascular tissue transfer for management of infected TKA can be successful in limb salvage (82%) but clinical outcomes in salvaged limbs were poor. Cite this article: Bone Joint J 2020;102-B(6 Supple A):176–180.
Collapse
Affiliation(s)
- Gwo-Chin Lee
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David L. Colen
- Department of Plastic and Reconstructive Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - L. S. Levin
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephen J. Kovach
- Department of Plastic and Reconstructive Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
25
|
Zeiderman MR, Bailey CM, Arora A, Pu LLQ. Anterior tibial vessel turnover as recipient vessel for complex free tissue transfer around the knee. J Plast Reconstr Aesthet Surg 2020; 73:1897-1916. [PMID: 32518051 DOI: 10.1016/j.bjps.2020.05.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/24/2020] [Accepted: 05/09/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Matthew R Zeiderman
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of California Davis Medical Center, Sacramento, California
| | - Chad M Bailey
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of California Davis Medical Center, Sacramento, California
| | - Aman Arora
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of California Davis Medical Center, Sacramento, California
| | - Lee L Q Pu
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of California Davis Medical Center, Sacramento, California.
| |
Collapse
|
26
|
Saaiq M, Zimri FUK. Clinical Applications and Outcome of Proximally Based Medial Gastrocnemius Muscle Flap. World J Plast Surg 2020; 9:22-28. [PMID: 32190587 PMCID: PMC7068190 DOI: 10.29252/wjps.9.1.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Gastrocnemius muscle flap has been in vogue for approximately five decades. The current study was carried out to document the indications and outcome of proximally based medial gastrocnemius muscle flap in our patients. METHODS This case series was conducted in Department of Plastic Surgery and Orthopedics, National Institute of Rehabilitation Medicine (NIRM), Islamabad, Pakistan during 3 years. It included all patients who were managed with proximally based medial gastrocnemius muscle flap for various indications. RESULTS There were 31 patients with 24 (77.41%) males and 7 (22.58%) females. The age ranged between 16- and 53 years (mean: 27.47±10.33 years). The indications for gastrocnemius muscle flap included traumatic defects with exposed tibia/ knee joint (n=20; 64.51%), prophylactic coverage of megaprosthesis employed for knee joint reconstruction (n=9; 29%), excisional defect of cutaneous squamous cell carcinoma with exposed tibia (n=1; 3.22%), and salvage of infected total knee arthroplasty (n=1; 3.22%). The hospital stay was 7-16 days (mean: 12.41±2.87 days). The flap survival in our series was 100%. There was partial skin graft in two patients (n=2; 6.45%). CONCLUSION Gastrocnemius muscle flap was a quick, easy and reliable coverage tool for small to moderate sized defects around the knee, the proximal third of the tibia as well as coverage of prosthesesis employed for knee arthroplasty. Inclusion of 2-4 cm tendon enhances the flap dimension without causing any additional morbidity.
Collapse
Affiliation(s)
- Muhammad Saaiq
- Department of Plastic Surgery and Orthopedics, National Institute of Rehabilitation Medicine (NIRM), Islamabad, Pakistan
| | - Farid Ullah Khan Zimri
- Department of Plastic Surgery and Orthopedics, National Institute of Rehabilitation Medicine (NIRM), Islamabad, Pakistan
| |
Collapse
|
27
|
Popliteal fossa reconstruction with medial genicular artery flap in a low resource setting: A report of two cases. Int J Surg Case Rep 2020; 68:129-131. [PMID: 32145564 PMCID: PMC7058840 DOI: 10.1016/j.ijscr.2020.02.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 02/22/2020] [Indexed: 11/25/2022] Open
Abstract
Large popliteal fossa defects require coverage with pliable tissues. Medial genicular artery flap satisfies this requirement. In a low income setting like ours, this flap is a veritable option.
Background Popliteal fossa defects are common arising from several causes. Options of reconstruction around the knee could be limited by the cause of defect or interventions. Medial genicular artery flap is known in the books but not in popular use despite its obvious advantages of superior vascularity, adequate size, suppleness, and hidden donor site. Aim To promote the use of this flap due to its advantages and ease of use especially in resource poor settings. Patients and methods We report two patients from a low resource setting aged 23 and 20 years respectively. The first case was managed for avulsion wound of the popliteal fossa while the second had post burn knee contracture release. The resultant large popliteal fossa defects on both patients were seen on clinical examination. Both patients were offered popliteal fossa reconstruction for the popliteal fossa defects using medial genicular artery flap with good outcome. Conclusion The medial genicular artery flap is a veritable option of popliteal fossa reconstruction especially for defects that are located contiguous to the flap and when other regional flap options are not available. Flap survival is excellent and donor site is hidden.
Collapse
|
28
|
[Reconstruction of lower limbs in old age-an interdisciplinary approach : Strategies for trauma surgery, vascular surgery and plastic surgery]. Chirurg 2019; 90:806-815. [PMID: 31501936 DOI: 10.1007/s00104-019-01023-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The treatment of complex injuries of the lower extremities in geriatric and/or multimorbid patients requires optimized preoperative and perioperative management as well as differentiated and interdisciplinary surgical approaches. Timely and definitive treatment should be strived for to avoid longer periods of immobilization. Temporary external stabilization of complex fractures, when necessary, should be followed by permanent loading stable internal osteosynthesis as soon as possible. Accompanying soft tissue defects are reconstructed after wound débridement using the full armamentarium of plastic and reconstructive surgical procedures, including microvascular free flap. In the context of perfusion compromised soft tissue situations, negative pressure wound therapy can provide sterile temporary defect coverage and aid in preconditioning poorly vascularized tissue before definitive reconstruction. A clarification of the vascular status in geriatric patients is paramount and relevant perfusion disorders should be treated either by intervention or open surgery before complex reconstructive interventions. Close interdisciplinary coordination of the various surgical procedures is imperative in order to guarantee an optimized stable reconstructive outcome with acceptable patient risk. Taking these principles into account, the reconstruction of complex trauma to the extremities can be carried out even in geriatric or multimorbid patients in specialized interdisciplinary surgical centers with excellent functional results.
Collapse
|
29
|
R RB, Ramkumar S, Venkatramani H. Soft Tissue Coverage for Defects around the Knee Joint. Indian J Plast Surg 2019; 52:125-133. [PMID: 31456621 PMCID: PMC6664846 DOI: 10.1055/s-0039-1688536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Soft tissue injuries around the knee present a challenge for providing a cover when there is loss of tissue. Various flaps comprising of skin and muscles around the joint have been described. Understanding the anatomical basis and the design of these flaps can aid in choosing the right flap for a given situation. A prompt cover of the defects aids in quicker healing and quicker rehabilitation of the patient.
Collapse
Affiliation(s)
- Ravindra Bharathi R
- Department of Plastic Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Sanjai Ramkumar
- Department of Plastic Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Hari Venkatramani
- Department of Plastic Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| |
Collapse
|
30
|
Scaglioni MF, Giunta G, Barth AA, Fritsche E, Arvanitakis M. Lower medial thigh perforator (LMTP) propeller flap for reconstruction of soft tissue defects around the knee. Microsurgery 2019; 40:298-305. [PMID: 31390101 DOI: 10.1002/micr.30499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 06/29/2019] [Accepted: 07/18/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Skin and soft-tissue defects around the knee are common and their reconstruction is still challenging and argued. Thin, pliable and well-vascularized tissues are required in order to restore the aesthetic appearance of the knee and facilitate joint function. Historically local muscle flaps were employed for the upper third of the lower limb reconstruction; however, since their introduction, different perforator flaps have been proposed for this purpose. The aim of this report is to share our clinical experience with the pedicled lower medial thigh perforator (p-LMT) flap for the reconstruction of skin and soft tissue defects around the knee. PATIENTS AND METHODS Between August 2013 and July 20, 2018, patients underwent pedicled LMT propeller flap reconstruction for defects around the knee. The subunits of the defects were the suprapatellar, the infrapatellar and patellar area and in two cases a full around the knee defect was reported. Cause of defects included trauma (13), tumor (4) and infection after knee operation (3) and defect sizes ranged from 4 × 3 cm2 to 7 × 8 cm2 . RESULTS Flap sizes ranged from 4 × 9 cm2 to 6 × 16 cm2 . One to two perforators based on the superficial femoral artery or descending genicular artery were found between the septum of satorius and vastus medialis, or piercing the vastus medialis during dissection. All flaps were rotated 180° in propeller fashion. All the donor sites were primarily closed and no complication at the donor site was detected. In the two cases of the total knee soft tissue defect, a double pedicled flaps reconstruction was required. After a 6 months follow-up, all the patients in the series achieved a full range of motion. CONCLUSIONS Fasciocutaneous flaps are currently the first reconstructive option for the soft tissue defects around the knee. The p-LMT flap reconstruction in this case series achieved good aesthetic and functional outcomes and this flap may be a valuable option for the reconstruction of the small to medium soft tissue defects around the knee.
Collapse
Affiliation(s)
- Mario F Scaglioni
- Department of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Gabriele Giunta
- Plastic and Reconstructive Surgery Department, Universitair Ziekenhuis Brussel (University Hospital Brussels), Vrije Universiteit Brussel, Brussels, Belgium
| | - Andrè A Barth
- Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Elmar Fritsche
- Department of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Michael Arvanitakis
- Department of Plastic and Hand Surgery, Kantonsspital Sant Gallen, St. Gallen, Switzerland
| |
Collapse
|
31
|
Amin NH, Speirs JN, Simmons MJ, Lermen OZ, Cushner FD, Scuderi GR. Total Knee Arthroplasty Wound Complication Treatment Algorithm: Current Soft Tissue Coverage Options. J Arthroplasty 2019; 34:735-742. [PMID: 30665832 DOI: 10.1016/j.arth.2018.12.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/10/2018] [Accepted: 12/12/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Wound complications associated with soft tissue defects following total knee arthroplasty present challenges for the orthopedic surgeon. The scale of early complications include less morbid problems, such as quickly resolving drainage and small superficial eschars, to persistent drainage and full-thickness tissue necrosis, which may require advanced soft tissue coverage. METHODS This review outlines current wound management strategies and provides an algorithm to help guide treatment and clinical decision-making. CONCLUSION A surgeon's understanding of soft tissue coverage options is essential in protecting the knee prosthesis from a deep infection and to obtain an optimal functional outcome.
Collapse
Affiliation(s)
- Nirav H Amin
- Department of Orthopedic Surgery, Loma Linda University, Loma Linda, CA
| | - Joshua N Speirs
- Department of Orthopedic Surgery, Loma Linda University, Loma Linda, CA
| | - Matthew J Simmons
- Department of Orthopedic Surgery, Sierra Pacific Orthopedic Center, Fresno, CA
| | - Oren Z Lermen
- Department of Plastic Surgery, Lenox Hill Hospital, New York, NY
| | - Fred D Cushner
- Department of Orthopedic Surgery, Lenox Hill Hospital, New York, NY
| | - Giles R Scuderi
- Department of Orthopedic Surgery, Lenox Hill Hospital, New York, NY
| |
Collapse
|
32
|
Reappraisal of Perforasomes of the Superficial Femoral, Descending Genicular, and Saphenous Arteries and Clinical Applications to Locoregional Reconstruction. Plast Reconstr Surg 2019; 143:613e-627e. [DOI: 10.1097/prs.0000000000005395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
33
|
Perrault D, Manrique OJ, Lee G, Carre AL, Oakes DA, Wong AK. Complex Reconstruction of the Knee with a Free Vertical Rectus Abdominis Flap after Periprosthetic Soft Tissue Necrosis. Cureus 2019; 11:e3969. [PMID: 30956921 PMCID: PMC6438685 DOI: 10.7759/cureus.3969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Periprosthetic joint infection (PJI) is limb threatening and difficult to treat. Although a two-stage re-implantation is accepted as the standard of care for PJI, extensive debridement, numerous surgeries, or liquifactive necrosis from the infection can result in a tissue defect. With a large tissue defect, soft tissue coverage is required to protect the prosthesis, fill any dead space, and obtain a satisfactory wound closure. With defects too large for local or regional flap coverage, free tissue transfer is the best option. We present a case in which soft tissue coverage with both medial and lateral gastrocnemius muscle flaps was not sufficient; free tissue transfer was necessary for both wound closure and creation of an adequate soft tissue envelope for the future placement of a prosthesis. Regardless of the complicated surgical history and extensive soft tissue damage, limb function was restored and the patient regained his independence.
Collapse
Affiliation(s)
- David Perrault
- Plastic Surgery, Keck School of Medicine of USC, Los Angeles, USA
| | | | - Gene Lee
- Plastic Surgery, Keck School of Medicine of USC, Los Angeles, USA
| | - Antione L Carre
- Plastic Surgery, Keck School of Medicine of USC, Los Angeles, USA
| | - Daniel A Oakes
- Orthopaedics, Keck School of Medicine of USC, Los Angeles, USA
| | - Alex K Wong
- Plastic Surgery, Keck School of Medicine of USC, Los Angeles, USA
| |
Collapse
|
34
|
Lucattelli E, Delcroix L, Baldrighi C, Tanini S, Innocenti M. Quadriceps tendon reconstruction using a fascia lata included in a reverse‐flow anterolateral thigh flap. Microsurgery 2019; 39:642-646. [DOI: 10.1002/micr.30420] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 10/10/2018] [Accepted: 12/12/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Elena Lucattelli
- Plastic and Reconstructive MicrosurgeryCareggi University Hospital Florence Italy
| | - Luca Delcroix
- Plastic and Reconstructive MicrosurgeryCareggi University Hospital Florence Italy
| | - Carla Baldrighi
- Plastic and Reconstructive MicrosurgeryCareggi University Hospital Florence Italy
| | - Sara Tanini
- Plastic and Reconstructive MicrosurgeryCareggi University Hospital Florence Italy
| | - Marco Innocenti
- Plastic and Reconstructive MicrosurgeryCareggi University Hospital Florence Italy
| |
Collapse
|
35
|
Niempoog S, Tanariyakul Y. Distally Based Sartorius Flap to Cover Knee Joint Defect. J Orthop Case Rep 2019; 9:43-45. [PMID: 31559225 PMCID: PMC6742873 DOI: 10.13107/jocr.2250-0685.1412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION The coverage of soft-tissue defects around the knee joint has many reconstructive techniques depending on the size, location, and depth. We report a case with large soft-tissue defect at anterior knee joint that primary closure cannot be done with successfully used distally based sartorius flap and full-thickness skin graft to cover this defect. CASE REPORT A 30-year-old man had a large skin defect at the knee following a motorcycle accident. The patella tendon and patella were exposed. We use the sartorius muscle flap to cover the wound defect. First, a skin incision was done on the muscle alignment. Then, the sartorius muscle was dissected, and the proximal set of segmental vessels was identified and ligated. Afterward, the sartorius was moved into subcutaneous tunnel and expanded to provide coverage for the wound defect. Finally, we used the full-thickness skin graft to cover over the muscle flap. The flap and graft were survived. The patient could return to work after 1 month after the operation. CONCLUSION In the case with soft-tissue defects around knee joint, there are many operative techniques. Our case has a large wound at anterior aspect of knee joint. We used the distally based sartorius flap to cover the wound defect. Following the transposition, the sartorius remained viable through out its length, and the patient had full post-operativerecovery.
Collapse
Affiliation(s)
- Sunyarn Niempoog
- Department of Orthopedics, Faculty of Medicine, Thammasat University, Thailand
| | - Yot Tanariyakul
- Department of Orthopedics, Faculty of Medicine, Thammasat University, Thailand,Address of Correspondence: Dr. Yot Tanariyakul, 95 Moo 8, Phaholyothin Road, Tambon Khlong Nung, Amphoe Khlong Luang, 10120, Chang Wat Pathum Thani, Thailand. E-mail:
| |
Collapse
|
36
|
Bigdeli AK, Thomas B, Schmidt VJ, Kotsougiani D, Hernekamp FJ, Hirche C, Kneser U, Gazyakan E. The conjoined parascapular and latissimus dorsi free flap for reconstruction of extensive knee defects. Microsurgery 2018; 38:867-875. [DOI: 10.1002/micr.30361] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 05/02/2018] [Accepted: 06/20/2018] [Indexed: 01/26/2023]
Affiliation(s)
- Amir K. Bigdeli
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen; Hand and Plastic Surgery, University of Heidelberg; Ludwigshafen Germany
| | - Benjamin Thomas
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen; Hand and Plastic Surgery, University of Heidelberg; Ludwigshafen Germany
| | - Volker J. Schmidt
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen; Hand and Plastic Surgery, University of Heidelberg; Ludwigshafen Germany
| | - Dimitra Kotsougiani
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen; Hand and Plastic Surgery, University of Heidelberg; Ludwigshafen Germany
| | - Frederick J. Hernekamp
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen; Hand and Plastic Surgery, University of Heidelberg; Ludwigshafen Germany
| | - Christoph Hirche
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen; Hand and Plastic Surgery, University of Heidelberg; Ludwigshafen Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen; Hand and Plastic Surgery, University of Heidelberg; Ludwigshafen Germany
| | - Emre Gazyakan
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen; Hand and Plastic Surgery, University of Heidelberg; Ludwigshafen Germany
| |
Collapse
|
37
|
Liu S, Wang Y, Kotian RN, Li H, Mi Y, Zhang Y, He X. Comparison of Nonabsorbable and Absorbable Suture in Total Knee Arthroplasty. Med Sci Monit 2018; 24:7563-7569. [PMID: 30350827 PMCID: PMC6354634 DOI: 10.12659/msm.910785] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Wound closure of KA is important for postoperative rehabilitation. At present there is still no consensus on the best wound closure technique for KA. We performed the present study to determine whether absorbable suture is better than nonabsorbable suture in total knee arthroplasty (TKA). Material/Methods A total of 180 patients who underwent TKA were divided into 3 groups: 80 cases of nonabsorbable suture, 50 cases of 2-0 absorbable suture, and 50 cases of 4-0 absorbable suture. The time required for closure, frequency of gauze change, length of stay in hospital, adverse events, range of motion (ROM) after 3 months postoperatively, and VAS score of wounds were calculated. Comparison was made to explore any significant differences between different groups. Results There were significant differences between the nonabsorbable group and the absorbable group with regards to closure time, frequency of gauze change, and hospital length of stay (LOS). Closure time was longer in the absorbable group than in the nonabsorbable group. Frequency of gauze change, hospital LOS, and adverse events were lower, and VAS was higher in the absorbable group. Closure time was longer in the 4-0 absorbable group than in the 2-0 group. There was no significant difference between the 4-0 group and 2-0 group in other variables. There was no significant difference in long-term ROM among all groups. Conclusions Absorbable suture in TKA reduces the incidence of fatty liquefaction, frequency of gauze change, and postoperative LOS. It improves the cosmetic appearance and overall reduces the economic cost. There was no significant effect on early and long-term functional ROM. In conclusion, absorbable suture can be used in TKA when appropriately indicated.
Collapse
Affiliation(s)
- Shuguang Liu
- Department of Orthopedics, Second Affiliated Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaan'xi, China (mainland).,Department of Joint Surgery, Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaan'xi, China (mainland)
| | - Yunmei Wang
- Department of Medical Oncology, Shaanxi Provincial Cancer Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaan'xi, China (mainland)
| | - Ronak N Kotian
- Department of Orthopedics, Victoria Hospital, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - Hui Li
- Department of Joint Surgery, Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaan'xi, China (mainland)
| | - Yufei Mi
- Department of Joint Surgery, Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaan'xi, China (mainland).,Department of Orthopedics, Orthopedic Hospital of Henan Province, Luoyang, Henan, China (mainland)
| | - Yumin Zhang
- Department of Joint Surgery, Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaan'xi, China (mainland)
| | - Xijing He
- Department of Orthopedics, Second Affiliated Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaan'xi, China (mainland)
| |
Collapse
|
38
|
Bekarev M, Goch AM, Geller DS, Garfein ES. Distally based anterolateral thigh flap: an underutilized option for peri-patellar wound coverage. Strategies Trauma Limb Reconstr 2018; 13:151-162. [PMID: 30276606 PMCID: PMC6249144 DOI: 10.1007/s11751-018-0319-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/25/2018] [Indexed: 11/28/2022] Open
Abstract
Wound coverage in the supra-patellar area presents a significant challenge for orthopaedic and reconstructive surgeons due to the need for preservation of knee joint function but the paucity of regional soft tissue flaps available. While many orthopaedic and reconstructive surgeons make use of the rotational gastrocnemius flap for coverage of peri-patellar defects, this flap has certain limitations. The goal of this study was to report a single-centre experience with the use of the distally based anterolateral thigh flap (ALT) and review the current literature on the use of the ALT for peri-patellar defects. In this report, both a single-centre experience using distally based anterolateral thigh (ALT) island flaps for supra-patellar wound coverage and the existing literature on this topic were reviewed. A systematic literature review was performed to assess the use of the ALT for peri-patellar wounds. Five patients with a mean age of 69 underwent a distally based ALT flap for coverage of peri-patellar defects. Four out of 5 flaps survived at the end of their respective follow-up. Based on this combined experience, the distally based reverse-flow anterolateral thigh island flap represents a useful but relatively underutilized option for appropriately selected supra-patellar wounds due to minimal donor site morbidity, multiple flap components, and predictable pedicle anatomy. The flap’s major weakness is its potentially unreliable venous drainage, requiring delay or secondary venous outflow anastomosis. Given the ALT flap’s favourable profile, the authors recommend consideration for its use when managing a peri-patellar coverage wound issue.
Collapse
Affiliation(s)
- Mikhail Bekarev
- Department of Orthopaedic Surgery, Montefiore Medical Center, 111 E 210th St, Bronx, NY, 10467, USA
| | - Abraham M Goch
- Department of Orthopaedic Surgery, Montefiore Medical Center, 111 E 210th St, Bronx, NY, 10467, USA.
| | - David S Geller
- Department of Orthopaedic Surgery, Montefiore Medical Center, 111 E 210th St, Bronx, NY, 10467, USA
| | - Evan S Garfein
- Department of Orthopaedic Surgery, Montefiore Medical Center, 111 E 210th St, Bronx, NY, 10467, USA
| |
Collapse
|
39
|
|
40
|
Khoshnevis J, Dashti T, Ebrahimi M, Azargashb E, Kalantar Motamedi M. Anastomosis of Free Flap Pedicle to Great Vessels. World J Plast Surg 2018; 7:351-356. [PMID: 30560076 PMCID: PMC6290300 DOI: 10.29252/wjps.7.3.351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Free Flaps are viable option to cover the tissue defect. Pedicle anastomosis to vessel branches has excellent result. In some situations which there is a possibility of flap failure like shortage of vessel branches, possibility of pedicle kinking or need to vein graft, anastomosis to great vessels is justified. METHODS Six patients were allocated to study. Five cases for free jejunal flap and one case for free latissimus flap. In free jejunal flap group, pedicle anastomosis was performed as an end-side fashion to common carotid artery and internal jugular vein and in free latissimus flap, pedicle was anastomosed as an end-side fashion to superficial femoral artery and superficial femoral vein. Follow up was regular up to 20 years. RESULTS In free jejunal flap group, there were three female and two male with age from 30 to 59 years. The sixth case was a thirteen years old male with flexion contracture of right knee who underwent free latissimus flap. Follow up was regular for 20 years. All flaps survived, and good functional result was obtained in all except one. CONCLUSION Choosing great vessels as one side of anastomosis is safe and can be done as a primary approach due to technical demand or as a final resort when there is shortage of side branches.
Collapse
Affiliation(s)
- Jalaluddin Khoshnevis
- General and Vascular Surgery, Shohada-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Terifeh Dashti
- Health Service Management, Clinical Research Development Center of Shohada-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ebrahimi
- General and Vascular Surgery, Shohada-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Eznollah Azargashb
- Department of Community Medicine, Shahid Beheshti University of Medical Sciences and Health Services, Shohada-Tajrish Hospital, Tehran, Iran
| | - Mohamadreza Kalantar Motamedi
- General and Vascular Surgery, Shohada-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
41
|
Scaglioni MF, Franchi A, Giovanoli P. Pedicled posteromedial thigh (pPMT) perforator flap and its application in loco-regional soft tissue reconstructions. J Plast Reconstr Aesthet Surg 2018; 71:217-223. [DOI: 10.1016/j.bjps.2017.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 09/19/2017] [Accepted: 10/04/2017] [Indexed: 11/26/2022]
|
42
|
Bouveau V, Potage D, Dubory A, Chevallier R, Meningaud JP, Niddam J, Flouzat-Lachaniette CH. A Distally Based Sartorius Muscle Flap for a Gustilo Grade-III Open Fracture of the Lateral Femoral Condyle and the Head of the Fibula with a Complex Soft-Tissue Defect: A Case Report and Review of the Literature. JBJS Case Connect 2017; 7:e93. [PMID: 29244658 DOI: 10.2106/jbjs.cc.17.00071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We present a case of lower-limb trauma associated with an extensive soft-tissue defect around the knee joint, which led to the exposure of bone and the metalwork that was used for the management of the associated fractures. Coverage was performed with a distally based sartorius muscle flap in a single-stage procedure, allowing good recovery with a nice aesthetic and functional outcome at the 1-year follow-up. Additionally, we discuss alternative options for the coverage of severe soft-tissue defects based on the clinical context. CONCLUSION A distally based sartorius muscle flap may be a suitable alternative for coverage of complex soft-tissue defects around the knee joint.
Collapse
Affiliation(s)
- Victoire Bouveau
- Departments of Orthopaedic Surgery (V.B., D.P., A.D., R.C., and C.-H.F.-L) and Plastic Surgery (J.-P.M and J.N.), Hôpital Henri Mondor (Assistance Publique-Hôpitaux de Paris), Université Paris Est Créteil (UPEC), Créteil Cedex, France
| | | | | | | | | | | | | |
Collapse
|
43
|
Li S, Liu Y, Zang M, Yu S, Guo W, Yang R. Rectus femoris branch: An alternative blood supply for a distally based anterolateral thigh flap. J Plast Reconstr Aesthet Surg 2017; 71:232-238. [PMID: 29175133 DOI: 10.1016/j.bjps.2017.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 08/28/2017] [Accepted: 10/13/2017] [Indexed: 10/18/2022]
Abstract
Successful raising of a distally based anterolateral thigh (dALT) flap mainly depends on a well-developed lateral circumflex femoral artery (LCFA) descending branch and an intact vascular connection between the descending branch and the vascular network of the knee. However, in some clinical scenarios, the descending branch is hypoplastic or the vascular connection of the knee is compromised. We present six cases of using dALT flaps in soft tissue defect reconstruction of the knee with either of the above-mentioned conditions. In these cases, the flaps relied on the reverse blood flow through the rectus femoris branch and showed complete survival postoperatively. We believe that the reverse flow from the rectus femoris branch could be an alternative blood supply for the dALT flap in the presence of hypoplasia of the LCFA descending branch or compromise of the vascular connection between the descending branch and the articular geniculate network.
Collapse
Affiliation(s)
- Shanshan Li
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yuanbo Liu
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
| | - Mengqing Zang
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Shengji Yu
- Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
| | - Rongli Yang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
| |
Collapse
|
44
|
Ismail H, El-Bassiony L. Reverse-flow anterolateral thigh perforator: an ad hoc flap for severe post-burn knee contracture. ANNALS OF BURNS AND FIRE DISASTERS 2016; 29:71-75. [PMID: 27857656 PMCID: PMC5108233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 12/26/2015] [Indexed: 06/06/2023]
Abstract
We evaluate function outcomes of the reverse-flow ALT perforator flap to reconstruct severe post-burn knee contracture. Between October 2012 and December 2014, 10 patients with severe post-burn knee contracture were subjected to reconstruction with 10 ipsilateral reversed-flow ALT perforator flaps. All the patients were male. Ages ranged from 15 to 47 years (mean = 32 years). Time from burn injury to patient presentation ranged from 2-8 months. All patients demonstrated post-burn flexion contracture of the knee joint, ranging from 35 to 75 degrees. Flap sizes ranged from 8×16 to 12×26 cm. The flaps and skin grafts were carried out without major complications. Only minor complications occurred, such as transient, mild congestion immediately after inset in two flaps. Two flaps developed superficial necrosis at the distal edge. One case sustained partial skin graft loss due to haematoma. One case complained of skin hyperpigmentation and hypertrophic scars around the graft. Secondary debulking procedures were required in two cases. The entire donor sites were closed by partial thickness skin graft with acceptable appearance, except one case that was closed primarily. Eight out of ten patients (80%) demonstrated gradual improvement in range of knee motion after a specialized rehabilitation program. Two patients (20%) did not get back full range of motion. RALT perforator flap is the cornerstone for the reconstruction of soft-tissue defects around the knee with acceptable aesthetic and functional results provided that the following items are fulfilled: inclusion of muscle cuff around the pedicle, the pivot point, prevention of pedicle compression after transfer and early surgical intervention on the post-burn knee contracture.
Collapse
Affiliation(s)
- H.A. Ismail
- Corresponding author: Hossam Ali Ismail,
Department of Plastic Reconstructive Surgery, Mansoura University, Mansoura, Egypt+20 502349020
| | | |
Collapse
|