Analysis of challenging reconstruction of soft tissue defects around the knee joint and evolving a treatment algorithm
Keywords:Reconstructive algorithm, Pedicled flaps, Reverse antero lateral thigh flap, Knee soft tissue defects
Background: The soft tissue defects around knee joint give a challenging experience to reconstruct. There are various ways to reconstruct soft tissue defects around knee joint. In this study, a reconstructive algorithm is formed for soft tissue defect around knee joint using pedicled flaps.
Methods: Reconstructive procedures were done for 15 cases of soft tissue defects around knee joints following different etiologies during the tenure of January 2017 to December 2018 in the Department of Burns, Plastic and Reconstructive Surgery, Kilpauk Medical College, Chennai.
Results: Soft tissue defects around knee joint need flap to have a durable cover, to protect the underlying structures – bones, vessels, tendon, and to enable ease of free movement of knee joint without producing contracture. There are various etiologies for soft tissue defects around knee joint-post traumatic injuries, post total knee replacement, post electric burn injuries, post burn scar contracture release of knee joint. 15 cases of soft tissue defects around knee joint were reconstructed using various pedicled flaps-medial thigh rotation flap, gastrocnemius muscle and myocutaneous flap, reverse anterolateral thigh flap, propeller flap. In this retrospective study, reconstructive algorithm for soft tissue defects around knee joint is provided.
Conclusions: The reconstruction of soft tissue defects around knee joint is difficult one. In this study, a simple reconstructive algorithm is provided based on the experience in Department of Burns, Plastic, and Reconstructive Surgery, Kilpauk Medical College, Chennai.
Yen-Ren K, Pl-Chung A, Mei-Hui K, Nai-Siong K, Shen-Fa Y, Seng-Feng J. Reconstruction of knee joint soft tissue and patellar tendon defects using a composite anterolateral thigh flap with vascularised fascia lata. J Plastic Reconstruc Aesthetic Surg. 2008;61(2):195-9.
Auregan JC, Begue T, Tomeno B, Masquelet AC. Distally based vastus lateralis muscle flap: A salvage alternative to address complex soft tissue defects around the knee. Orthopae Traumatol: Surg Res. 2010;96:180-4.
Sahasrabudhe P, Panse N, Baheti B, Jadhav A, Joshi N, Chandanwale A. Reconstruction of complex soft tissue defects around the knee joint with distally based split vastus lateralis musculocutaneous flap: A new technique. J Plastic Reconstruc Aesthetic Surg. 2015;68(1):35-9.
Demirseren ME, Efendioglu K, Demiralp CO, Kilicarslan K, Akkaya H. Clinical experience with a reverse flow anterolateral thigh perforator flap for the reconstruction of soft tissue defects of the knee and proximal lower leg. J Plastic Reconstruc Aesthet Surg. 2011;64(12):1613-20.
Rao AJ, Kempton SJ, Erickson BJ, Levine BR, Rao VK. Soft tissue reconstruction and flap coverage for revision total knee arthroplasty. J Arthroplasty. 2016;31(7): 1529-38.
Wagner T, Hupkens P, Slater NJ, Ulrich DJO. The proximally based long peroneal muscle turnover flap: A novel salvage flap for small to medium sized defects of the knee. J Plastic Reconstruc Aesthet Surg. 2016;68(4):533-7.
Amin NH, Speirs JN, Simmons MJ, Lermen OZ, Cushner FD, Scuderi GR. Total knee arthroplasty wound complication treatment algorithm: Current soft tissue coverage options. J Arthroplasty. 2019;34(4):735-42.
Gravvanis A, Kyriakopoulos A, Kateros K, Tsoutsos D. Flap reconstruction of the knee: A review of current concepts and a proposed algorithm. World J Orthopedics. 2014;5(5):603-13.