Medial gastrocnemius rotational flap for the reconstruction of extensor mechanism disruption in periprosthetic knee infections: a retrospective series with minimum two year follow-up

Russo, Antonio; Clemente, Antonio; Massè, Alessandro; Burastero, Giorgio

doi:10.1007/s00264-023-05716-x

Cited by 4 publications

(6 citation statements)

References 34 publications

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“…The remaining 22 studies 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 met all of the inclusion criteria and were included in our systematic review. The articles consisted of case series ( n = 14, 63.6%) 14 15 16 17 19 20 21 24 25 29 31 32 or case reports ( n = 8, 36.4%). 18 22 23 26 27 28 30 33 There were no controlled trials investigating the usage of autologous flaps for knee extensor mechanism reconstruction.…”

Section: Resultsmentioning

confidence: 99%

“…studies using the same technique have reported an extension lag of less than 10 degrees, with improved ambulation for all patients, enabling them to walk without the use of a cane or walker. 15,18,20,22,29,31 These studies suggest that while the use of an extended gastrocnemius flap may result in varying degrees of postoperative extensor lag, it significantly improves the knee extensor mechanism, with patients all showing improvements in ambulation.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…In cases involving gastrocnemius muscle flaps, the mean postoperative flexion averaged 98.08 degrees, with an extension lag of 8.52 degrees. [14][15][16][17][18][19][20][21][22][24][25][26][27][28][29][30][31]33 (Table 4a)…”

Section: Functional Outcomesmentioning

confidence: 99%

“…Information on range of motion was detailed in 22 studies, providing mean values for flexion and extensor lag. In cases involving gastrocnemius muscle flaps, the mean postoperative flexion averaged 98.08 degrees, with an extension lag of 8.52 degrees [14][15][16][17][18][19][20][21][22][24][25][26][27][28][29][30][31]33 (►Table 3). For studies employing quadriceps muscle transposition, the mean postoperative flexion was 109.5 degrees, accompanied by an extension lag ranging from 0 to 65 degrees 13,23,34 (►Table 4).…”

Section: Functional Outcomesmentioning

confidence: 99%

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A Systematic Review of Clinical Outcomes of Pedicled Flap Repairs of the Knee Extensor Mechanism

Lee,

Fisher,

McNamara

et al. 2024

J Reconstr Microsurg

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Background Rupture of the extensor mechanism of the knee has severe functional morbidity, and repair can be complicated by infection, allograft degeneration, and recurrent rupture. Techniques of autologous tissue repair utilizing pedicled flaps such as the gastrocnemius offer vascularized methods of reconstruction, with potentially diminished complication rates. The goal of this study was to evaluate the functional outcomes and complications associated with pedicled flap repair of the knee extensor mechanism. Methods A systematic review was conducted following PRISMA guidelines. Publications that focused on local myocutaneous flaps as a means for reconstruction were included. Causes for knee extensor mechanism deficit, flap characteristics, ambulation rate, changes in range of motion pre- and post-operation, and postoperative complications were analyzed. Technique reports including primary suture repairs, synthetic mesh, and allograft use were excluded. Results An initial 119 studies were identified, with final review of 22 observational studies encompassing 128 cases of pedicled flap reconstructions. The gastrocnemius (88.2%, n=113), quadriceps (6.3%, n=8), and a combination of the vastus and gastrocnemius flaps (5.5%, n=7), were the most frequently utilized flaps. Functional outcomes were favorable with 87.2% of patients achieving ambulation without external support. Variability in range of motion outcomes across different flap may be secondary to the patient characteristics as well as extent of initial injury. Conclusions Autologous pedicle flap reconstruction of the knee extensor mechanism emerges as a viable option for cases characterized by extensive defects and insufficient soft tissue coverage, which are not amenable to direct suture repairs or allografts. Postoperative assessments revealed that the majority of patients experienced improved ambulation status, with no instances of deterioration noted among the patients.

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Section: Resultsmentioning

confidence: 99%

Section: Accepted Manuscriptmentioning

confidence: 99%

Section: Functional Outcomesmentioning

confidence: 99%

Section: Functional Outcomesmentioning

confidence: 99%

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A Systematic Review of Clinical Outcomes of Pedicled Flap Repairs of the Knee Extensor Mechanism

Lee,

Fisher,

McNamara

et al. 2024

J Reconstr Microsurg

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“…One of the possible strategies is to increase the quality of the suturing phase [ 35 ]. In fact, even if often overlooked, an appropriate suturing technique has a primary relevance for the overall outcome of surgeries and can help prevent devastating complications [ 36 , 37 ]. Barbed sutures have already been proven to result in excellent outcomes in hand surgery and surgery of the knee.…”

Section: Discussionmentioning

confidence: 99%

The Use of Barbed Sutures in Total Hip Arthroplasty: A Systematic Review on Clinical–Surgical Outcomes, Costs, and Complications

Russo,

Centola,

Nicodemo

et al. 2024

Healthcare

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Purpose: Total hip arthroplasty is among the most successful procedures in orthopaedic surgery. As the total number of total hip arthroplasties is constantly rising and it is expected to further increase, efforts oriented to optimise surgical pathways are investigated, aiming to reduce complications and diminish costs. The wound suturing phase is one of the steps that may be addressed. Barbed sutures have proved to reduce surgical times and enhance suture stability, then reducing wound-related complications in many surgical fields. The evidence on the use of this technology in total hip arthroplasty is still sparse, and its effect on patient outcomes and costs must still be clarified. Methods: A systematic search of studies published from 1 January 2000 to 1 March 2023 was performed. Two authors independently reviewed the literature available in eight electronic databases to identify papers eligible for inclusion. Results: A total of nine studies investigating 6959 procedures on 6959 patients were included in the final analysis. Five studies were randomised controlled trials, and the overall quality of studies ranged from moderate to high. The mean age of patients ranged from 43.8 to 70 years. BMI ranged from 25 to 31.9 kg/m2. The mean follow-up of studies ranged from 3 to 6 months. Conclusions: Evidence included in the systematic review suggested that the use of barbed sutures is associated with lower suturing times, complication rates, and overall costs when compared to the use of traditional suturing techniques. Level of evidence: II, systematic review of level I and II studies.

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Unbalanced metaphyseal fixation is associated with an increased aseptic loosening of revision total knee arthroplasty at mean 4-year follow-up

Russo,

Alessio-Mazzola,

Massè

et al. 2024

Arch Orthop Trauma Surg

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Medial gastrocnemius rotational flap for the reconstruction of extensor mechanism disruption in periprosthetic knee infections: a retrospective series with minimum two year follow-up

Cited by 4 publications

References 34 publications

A Systematic Review of Clinical Outcomes of Pedicled Flap Repairs of the Knee Extensor Mechanism

A Systematic Review of Clinical Outcomes of Pedicled Flap Repairs of the Knee Extensor Mechanism

The Use of Barbed Sutures in Total Hip Arthroplasty: A Systematic Review on Clinical–Surgical Outcomes, Costs, and Complications

Unbalanced metaphyseal fixation is associated with an increased aseptic loosening of revision total knee arthroplasty at mean 4-year follow-up

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