Bilateral Gastrocnemius Flap For Harlequin Defects Around The Knee

Abstract


 
 
 
 Background : Tibial plateau fractures (especially bicondylar Schatzker type 5 and type 6) are a result of high energy trauma. Along with bony component, soft tissue injury is a major determinant in the treatment and final outcome. Bicondylar fractures needs bicolumnar fixation and as such require separate approaches: postero-medial and lateral incisions. The soft tissue of the proximal tibia swells significantly after the injury, coupled with extensive soft tissue dissection during fixation this can lead to subsequent wound breakdown and infection along either side of the proximal tibia which resembles “harlequin eyes”. This study describes outcome of management of post operative soft tissue complications following bicolumnar fixation of proximal tibia with medial and lateral gastrocnemius flap.
 Method : Three patients who had bilateral soft tissue necrosis at surgical incision sites treated with debridement and bilateral gastrocnemius flaps between January 2016 and December 2017 were included in this study. The mean age was 38 years (range 18–50 years) and the mean duration of follow-up was 10 months. Outcome assessments included the condition of the flap and fracture healing time.
 Result : All fractures united after surgery. There were no soft tissue complications and all flaps healed well. The mean bony union time was 6 months.
 Conclusion: Our technique of covering soft tissue loss at surgical site on medial and lateral side of proximal tibia with bilateral gastrocnemius flap in the same setting is a reliable and safe surgical method for these conditions.
 
 
 

Bilateral Gastrocnemius Muscle Flap for Bilateral Defects of Knee Joint in Schatzker Type V & VI Proximal Tibial Condyle Fractures

“…However, one of our cases developed soft tissue infection in the postoperative period which subsided with dressing and antibiotics. Hari and colleagues 4 first time described such a defect as Harlequin defect and reported 3 cases using bilateral gastrocnemius muscle flap with a mean duration of follow up of 10 months. They found bony union in all cases with a mean union time of 6 months and no soft tissue complications.…”

“…Using both the bellies of muscle for 2 separate defects on both sides of the knee is less described in the literature. 4 This paper aims to assess the utility of using both the bellies of gastrocnemius which is a regional muscle flap option that can be used to cover the 2 defects that are far apart on both sides of the knee. Its easy harvest, well-defined vascularity and less donor site morbidity make it a simpler option for such defects.…”