Quadriceps tendon reconstruction using a fascia lata included in a reverse‐flow anterolateral thigh flap

Lucattelli, Elena; Delcroix, Luca; Baldrighi, Carla; Tanini, Sara; Innocenti, Marco

doi:10.1002/micr.30420

Cited by 10 publications

(13 citation statements)

References 15 publications

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“…This case showed the first successful application of a free chimeric DIEP flap, consisting of triple‐component including the RAM, the anterior sheath of the RAM, and the skin paddle, for the reconstruction of a complex knee defect. Although a simple knee skin defect can be treated with various local flaps such as a perforator‐based propeller flap and with a reverse ALT flap, a complex knee defect requires three‐dimensional reconstruction; in the present case, neither a propeller flap or a reverse ALT flap was not available (Blondeel, 1999; Koshima et al, 1993; Li et al, 2018; Lucattelli et al, 2019; Wei et al, 2002; Yamamoto, Yamamoto, Kageyama, et al, 2020a). Well vascularized tissue such as muscle flap is suitable for active patellar osteomyelitis control, because antibiotics‐contained bone cement is hardly applicable for the patella's stump (Mayoly et al, 2018; Topalan et al, 2010; Yamamoto, Saito, et al, 2016a; Yamamoto, Yamamoto, Kageyama, et al, 2020a).…”

Section: Discussionmentioning

confidence: 91%

“…Well vascularized tissue such as muscle flap is suitable for active patellar osteomyelitis control, because antibiotics‐contained bone cement is hardly applicable for the patella's stump (Mayoly et al, 2018; Topalan et al, 2010; Yamamoto, Saito, et al, 2016a; Yamamoto, Yamamoto, Kageyama, et al, 2020a). Vascularized fascia is preferred for hard structure reconstruction in a contaminated wound, as artificial mesh or non‐vascularized fascial graft has a higher risk of infection (Knox et al, 2006; Koshima et al, 1993; Lu et al, 2011; Lucattelli et al, 2019; Yamamoto, 2019). Free fascial grafting combined with myocutaneous flap transfer would be used in this case, but there would be a significant risk of fascial graft infection even with myocutaneous flap placed on the graft, because actively‐infected patella was located just above the capsule.…”

Section: Discussionmentioning

confidence: 99%

“…Reconstruction of a complex knee defect is challenging, especially when complicated with deep infection such as osteomyelitis (Li, Li, & Tan, 2018; Topalan, Guven, & Demirtas, 2010). Complex knee defect requires not only skin coverage but also secure reconstruction of the knee joint with a strong membranous tissue (Li et al, 2018; Lu, Gong, Cui, & Liu, 2011; Lucattelli, Delcroix, Baldrighi, Tanini, & Innocenti, 2019). When a defect is complicated with osteomyelitis of the patella, artificial materials cannot be used for the knee joint reconstruction, and infection control is needed with sufficient debridement and coverage of the debrided surface with well‐vascularized tissue such as the muscle flap, as antibiotics‐contained bone cement is hardly applicable for the lesion (Knox et al, 2006; Lu et al, 2011; Mayoly et al, 2018; Yamamoto, Saito, Ishiura, & Iida, 2016a).…”

Section: Introductionmentioning

confidence: 99%

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A triple‐component deep inferior epigastric artery perforator chimeric free flap for three‐dimensional reconstruction of a complex knee defect complicated with patella osteomyelitis

Yamamoto

2020

Microsurgery

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Reconstruction of a complex knee defect is challenging, especially when complicated with osteomyelitis. Complex knee defect requires multi‐component three‐dimensional reconstruction using a chimeric flap. Although anterolateral thigh (ALT) flap is the most workhorse chimeric flap, another chimeric flap is required when ALT flap is not available. In this report, we present a case of complex knee defect successfully treated with a free triple‐component chimeric deep inferior epigastric artery perforator (DIEP) flap transfer. A 36 year‐old male sustained right above‐knee amputation and Gustilo IIIB open fracture of the left patella after being run over by a train. Stump formation was performed for the right limb amputation, and the left knee wound resulted in skin necrosis complicated with patella osteomyelitis. After debridement, the left knee wound showed a 3 × 2 cm articular capsule defect, 5 × 2 cm exposed patella stump, and a 16 × 9 cm skin defect. A triple‐component chimeric DIEP flap, containing a 7 × 3 cm rectus abdominis muscle (RAM), a 3 × 2 cm RAM's fascia, and a 23 × 10 cm skin was transferred. The RAM's fascia was used to reconstruct the joint, the RAM to cover the exposed patella's stump and the reconstructed joint, and the skin paddle to cover the skin defect. Six months after the surgery, the patient could walk without osteomyelitis recurrence, and there was no limitation in the left knee joint's range of motion. Although indication is limited, a multi‐component chimeric DIEP flap may be an option for three‐dimensional reconstruction of a complex defect.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A triple‐component deep inferior epigastric artery perforator chimeric free flap for three‐dimensional reconstruction of a complex knee defect complicated with patella osteomyelitis

Yamamoto

2020

Microsurgery

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“…Few groups have published case reports on reconstruction of patellar and quadriceps tendon defects. 20,21 However, the patients sustained remarkable range of motion deficiencies, with loss of 20 degree extension and 120 degree of flexion. 20 Future studies must evaluate range of motion after reconstruction in larger patient cohorts to ensure that a stable gait cycle can be reconstituted.…”

Section: Reconstructive Locationsmentioning

confidence: 99%

Long Term Follow-up of Composite Flaps for Single-stage Reconstruction of Concomitant Tendon and Soft Tissue Defects

Bekeny¹,

Zolper²,

Dekker³

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: Tendon rupture in the setting of significant soft tissue loss poses a challenging reconstructive situation, which requires (1) recreating a stable gait cycle, (2) reducing shear forces and re-rupture risk, and (3) providing adequate soft tissue coverage. In this study, we outline our experience with composite flaps in single-step reconstruction of various lower extremity tendinous injuries with soft tissue loss. Methods: A retrospective review of all patients requiring free tissue transfer at our tertiary wound care center between 2011 and 2020 was performed. Patients undergoing single-stage free tissue transfer for both soft tissue coverage and tendon reconstruction were selected. Variables of interest included demographics, comorbid conditions, baseline functionality, reconstructive details, and wound characteristics. Outcomes of interest were flap success, return to ambulation, time to ambulation, and postoperative complications. Results: Nineteen patients were included in this study. Patients were on average 48.0 years old (SD 16.5), with a median Charlson Comorbidity Index of 1.00 (IQR: 0.0–2.5). Defects were most often on the ankle (n = 1 3, 68.4%), with extension to the foot or leg in six of these cases. Median wound size was 68.0 cm 2 (IQR: 48.0–120.0). The most common tendon requiring reconstruction was the Achilles (n = 13, 68.4%). An anterolateral thigh flap with attached fascia lata extension rolled into a neotendon was used in all 19 cases. At baseline, all patients were ambulatory. Only one patient (5.3%) required return to the operating room for suspected vascular compromise. At a median of 14.4 months (IQR: 8.5–40.5), all 19 patients were ambulatory. Conclusions: Simultaneous reconstruction of tendinous injuries and soft tissue defects can be readily achieved via composite free flaps. Although other methods of reconstruction can be considered for smaller soft tissue and tendon loss, this approach has significant utility for patients with large defects and yields robust return to preinjury functionality.

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“…The most common site of tendon defect was the Achilles (n ¼ 151, 86.8%), followed by the patellar tendon (n ¼ 17, 9.8%). Other tendon defects reconstructed with composite flaps included the quadriceps tendon, 15 medial patellofemoral ). The size of the tendon defect was described in 14 studies, with defects averaging 8.4 cm (SD 4.0).…”

Section: Patient Demographics and Defect Characteristicsmentioning

confidence: 99%

Composite Free Tissue Transfer for Reconstruction of Lower Extremity Tendon Injuries: A Systematic Review

Sayyed

Bekeny

Day

et al. 2022

J Reconstr Microsurg

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Background Tendon rupture with extensive soft tissue loss has few reconstructive options. Composite free tissue transfers including skin and tendon offer an attractive reconstructive approach. Unfortunately, most studies discussing them come from sparse case reports. We systematically assess evidence supporting composite flap use in single-stage reconstruction of lower extremity tendon and soft tissue defects. Methods A systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. OvidMEDLINEqueried for records pertaining to the study question using Medical Subject Heading (MeSH) terms such as “lower extremity,” “tendon,” and “composite flap.” No limitations were placed on the year of publication, country of origin, or study size. Study characteristics and patient demographics were collected. Primary outcomes included:(1) defect location, composite flap characteristics;(2) return to ambulation;(3) joint range of motion;(4) patient satisfaction, and (5) complications. Results In total, 29 articles examining 173 patients with lower extremity tendon defects and soft tissue loss were identified. Average age was 44.3 years (SD 17.5); most patients were male (n = 110, 66.3%). Achilles defect was mostly reported (n = 151, 86.8%), followed by patellar (n = 17, 9.8%) and other tendon defects (n = 6, 3.4%). Average tendon defect size was 8.4 cm (SD 4.0), average soft tissue loss was 80.2 cm2 (SD 40.0). Most employed composite flap was anterolateral thigh and fascia lata (ALT + FL) (n = 101, 58.0%). Most patients (n = 134, 99.3%) returned to ambulation in an average 123.1 days (SD 78.3). Average reconstructive joint degree of motion was 62.1 degrees compared with normal degree of motion 62.3 degrees. Patient-reported outcomes demonstrated increased satisfaction after reconstruction. Conclusion Composite flaps effectively reconstruct a variety of tendon and soft tissue defects; the most reported flap is ALT + FL, which provides large flap territories and rapid healing in Achilles, patellar, and other tendon defects. In this review, patients with composite flaps demonstrated return to ambulation, minimal impairment in range of motion, and notable postoperative satisfaction.

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Quadriceps tendon reconstruction using a fascia lata included in a reverse‐flow anterolateral thigh flap

Cited by 10 publications

References 15 publications

A triple‐component deep inferior epigastric artery perforator chimeric free flap for three‐dimensional reconstruction of a complex knee defect complicated with patella osteomyelitis

A triple‐component deep inferior epigastric artery perforator chimeric free flap for three‐dimensional reconstruction of a complex knee defect complicated with patella osteomyelitis

Long Term Follow-up of Composite Flaps for Single-stage Reconstruction of Concomitant Tendon and Soft Tissue Defects

Composite Free Tissue Transfer for Reconstruction of Lower Extremity Tendon Injuries: A Systematic Review

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