Soft Tissue Reconstruction for Deep Defects over a Complicated Total Knee Arthroplasty: A Systematic Review

Abstract

Deep soft tissue defects after complicated primary or revision total knee arthroplasty (TKA) can be devastating to the patient and technically challenging. The purpose of this review was to (1) discuss different methods used to provide coverage for deep defects of the knee following TKA, as well as to (2) report on their success rates. A comprehensive literature search was performed. Reports were only included if they (1) were case series, (2) were level III studies or above (including retrospective cohort studies and meta-analyses), (3) were in English, and (4) discussed the outcome of graft or flap coverage of soft tissue defects after total knee arthroplasty. A total of 28 case series and four retrospective comparative studies were retrieved. In 16 studies, 195 out of 241 patients who received gastrocnemius flaps (81%) experienced successful outcomes. In seven studies including 84 patients that underwent fasciocutaneous flap coverage, over 90% of patients experienced successful outcomes. In the four studies examining 144 patients with delayed versus prophylactic soft tissue reconstruction, up to 81% of patients experienced a successful outcome. Various factors must be taken into consideration when assessing full-thickness defects over a TKA and collaboration between plastic and orthopaedic surgeons is required to select the optimal approach.

The Proximal Placement of the Knee Joint in the 1-Stage Treatment of Infected Knee Revisions With Large Anterior Soft Tissue Defects

“…[30][31][32][33] As larger soft tissue defects are appreciated, more difficult techniques, such as free muscle flaps, were required. [30][31][32][33] Around the knee, the gastrocnemius muscle flaps are the most common local flaps we used. Depending on the size of the defects, free flaps were harvested from many different locations, usually with the largest being from the latissimus dorsi.…”

“…For patients with small anterior soft tissue defects, adjacent soft tissue transfers or local muscle flaps with split-thickness skin grafts were used. [30][31][32][33] As larger soft tissue defects are appreciated, more difficult techniques, such as free muscle flaps, were required. [30][31][32][33] Around the knee, the gastrocnemius muscle flaps are the most common local flaps we used.…”

Surgical and patient-reported outcomes after total knee arthroplasty requiring soft tissue flap reconstruction – A 12-year experience from high-volume arthroplasty hospital

“…There are no treatment guidelines for these challenging situations, but there are, however, a few treatment algorithms based on the experiences of single tertiary care centres. [7][8][9][10][11] .…”