Gastrocnemius Myocutaneous Flaps for Knee Joint Coverage

Abstract

In addition to its reliability and very easy harvesting, the gastrocnemius MCF allows a robust joint coverage and good skin resurfacing that makes eventual revision easier and allows early radiotherapy. Furthermore, skin paddle also increases the effective area of the flap. This technique should always be considered with the other classic alternatives.

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

“…Although a conventional myocutaneous flap includes the muscle, the deep fascia, and the skin, the arrangement of the three components is different from that required in the present case; the complex knee defect in this case required the deep fascia for the articular capsule repair in the deepest layer, the muscle for osteomyelitis control in the middle layer, and the skin for coverage in the most superficial layer (Koshima et al, 1993; Lu et al, 2011; Mayoly et al, 2018; Yamamoto, 2019; Yamamoto, Yamamoto, Kageyama, et al, 2020a). To re‐arrange the three components for an optimal inset, a chimeric flap elevation was required; the three components should be nourished separately by three branches from the deep inferior epigastric artery (Hallock, 2008b; Yamamoto, Saito, et al, 2016a; Yamamoto, Yamamoto, Kageyama, et al, 2020a).…”

“…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). 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).…”

“…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). Therefore, multi‐component chimeric flap is required for complex knee reconstruction (Hallock, 2008a; Yamamoto, 2019; Yamamoto, Saito, et al, 2016a).…”

Modified Medial Gastrocnemius Myocutaneous Flap Technique for Knee Joint Coverage after Total Knee Arthroplasty

“…The medial gastrocnemius muscle flap is, therefore, currently the work- Mild wound dehiscence in case 3 healed well with conservative management. horse for covering defects in the anterior aspect of the knee, with its high success rate, ease of harvesting, minimal donorsite morbidity, capacity to fill dead space, and efficiency against infections [4]. However, the disadvantages of the medial gastrocnemius muscle flap include its limited length and the inadequate distal volume of the flap, which make it difficult to cover superior or lateral knee defects.…”

Modified lateral gastrocnemius myocutaneous flap with extended anterior and/or inferior boundary

“…Although perforator flaps and vascularized free flaps have been reported to reconstruct these defects more frequently 1 – 3 , gastrocnemius muscular and myocutaneous flaps remain good alternatives for repairing these defects due to their relatively easy and quick procedure, large dimension, and reliable survival 4 – 6 . The medial gastrocnemius myocutaneous flap with a larger dimension and wider reach was applied more frequently to cover these defects 7 , 8 , while the lateral gastrocnemius myocutaneous (LGM) flap was used to resurface the defects when the defects were predominantly located in the lateral aspect of the regions mentioned above or when the medial gastrocnemius myocutaneous flap was unsuitable because its integrity was destroyed 9 , 10 . In 1978, according to a latex injection study that included fluorescence examination in vivo and ultimate flap survival in humans, McCraw et al 11 proposed that the boundaries of the LGM flap were as follows: the medial (posterior) margin was the midline posteriorly, the inferior margin was 10 cm above the lateral malleolus, and the anterior margin overlapped the fibula and could be expanded to carry skin over the lateral (but not the anterior) compartment.…”