Soft Tissue Reconstruction and Flap Coverage for Revision Total Knee Arthroplasty

Rao, Allison J.; Kempton, Steve J.; Erickson, Brandon J.; Levine, Brett R.; Rao, Venkat K.

doi:10.1016/j.arth.2015.12.054

Cited by 52 publications

(50 citation statements)

References 60 publications

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“…The introduction of pedicled perforator propeller flaps gained popularity for the reconstruction of the middle and lower third over the last decade; however the optimal management of the upper one third of the leg and around the knee defects is still controversial (Gir et al, ; A. Gravvanis et al, ). Despite that the gastrocnemius flap has represented the workhorse for knee coverage, mostly after infections or in knee prosthesis exposure, this technique may require a skin graft over the transposed muscle and may cause a functional morbidity (A. Gravvanis et al, ; Rao, Kempton, Erickson, Levine, & Rao, ).…”

Section: Discussionmentioning

confidence: 99%

“…After, Fujiwara reported also a case of reconstruction performed by an ALT advancement flap based on the anterograde flow (Fujiwara, Chen, Ghetu, Jeng, & Kuo, ). However, reverse‐flow ALT flap in upper third of the leg reconstruction may often be complicated by vascular insufficiency because of the kinking of the pedicle during the insetting and in those cases a supercharged flap should be performed (Demirseren et al, ; Fujiwara et al, ; Rao et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…Despite that the gastrocnemius flap has represented the workhorse for knee coverage, mostly after infections or in knee prosthesis exposure, this technique may require a skin graft over the transposed muscle and may cause a functional morbidity (A. Gravvanis et al, 2014;Rao, Kempton, Erickson, Levine, & Rao, 2016).…”

Section: Discussionmentioning

confidence: 99%

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Lower medial thigh perforator (LMTP) propeller flap for reconstruction of soft tissue defects around the knee

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Lower medial thigh perforator (LMTP) propeller flap for reconstruction of soft tissue defects around the knee

et al. 2019

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“…It is mostly used to cover lateral knee defects (Andres et al, 2009;Osei et al, 2016;Gravvanis, 2014). In summary, the gastrocnemius flap has proved as a robust option for reconstructing small to moderate knee defects with good functional results (Andres et al, 2009;Osei et al, 2016;Rao et al, 2016;Gravvanis, 2014;Menderes et al, 2002). However, it may be less effective for reconstruction of more complex, proximal, and larger knee defects (Andres et al, 2009;Osei et al, 2016;Rao et al, 2016;Gravvanis, 2014;Menderes et al, 2002).…”

Section: Discussionmentioning

confidence: 99%

“…In summary, the gastrocnemius flap has proved as a robust option for reconstructing small to moderate knee defects with good functional results (Andres et al, 2009;Osei et al, 2016;Rao et al, 2016;Gravvanis, 2014;Menderes et al, 2002). However, it may be less effective for reconstruction of more complex, proximal, and larger knee defects (Andres et al, 2009;Osei et al, 2016;Rao et al, 2016;Gravvanis, 2014;Menderes et al, 2002). The distally based pedicled gracilis flap, based on minor pedicles from the superficial femoral or popliteal artery, is an option for coverage of more proximal or lateral knee defects (Osei et al, 2016;Mitsala et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

The conjoined parascapular and latissimus dorsi free flap for reconstruction of extensive knee defects

et al. 2018

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Background Extensive soft‐tissue defects affecting the knee region pose a significant reconstructive challenge and may require separate or multiple flaps for coverage. We evaluated the conjoined parascapular and latissimus dorsi free flap as an alternative reconstructive option. Methods From January 2013 to December 15, 2016 patients (7 female and 8 male) with a mean age of 47.5 years underwent reconstruction of such defects. Causes were trauma (12 cases) and infection (3 cases). The mean defect size was 40.9 × 20.8 cm (range, 21.4×7.3 to 60.1×40.5 cm). The mean defect surface area was 820.0 cm2 (range, 273.2‐2,400.4 cm2). The conjoined free flap was anastomosed to the femoral vessels in the adductor canal with (3 cases) or without an arterio‐venous loop (8 cases), posterior tibial vessels (3 cases), or anterior tibial vessels (1 case). Results Postoperatively, 10 patients experienced a total of 14 complications, of which 9 (7 patients) were considered major (requiring additional surgery) and 5 (4 patients) minor (conservative treatment). There was no total flap loss. Partial flap loss occurred in 5 patients. Major donor‐site complications occurred in 6 patients with impaired wound healing (4 cases), seroma (1 case), and hematoma (1 case). Reconstruction was successful in 14 out of 15 patients during a mean follow‐up time of 28.6 months (range, 6.0‐52.5 months). Twelve patients were able to walk at the last follow‐up visit. Conclusions The conjoined parascapular and latissimus dorsi free flap is a large and reliable flap. It allows for simultaneous 1‐stage reconstruction of complex and unusually large soft‐tissue defects of the knee region.

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Soft Tissue Reconstruction of the Thigh

Hansen

Bell

2020

Handbook of Lower Extremity Reconstruction

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Soft Tissue Reconstruction and Flap Coverage for Revision Total Knee Arthroplasty

Cited by 52 publications

References 60 publications

Lower medial thigh perforator (LMTP) propeller flap for reconstruction of soft tissue defects around the knee

Lower medial thigh perforator (LMTP) propeller flap for reconstruction of soft tissue defects around the knee

The conjoined parascapular and latissimus dorsi free flap for reconstruction of extensive knee defects

Soft Tissue Reconstruction of the Thigh

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