Medial Gastrocnemius Flap for Reconstruction of the Extensor Mechanism of the Knee Following High-Energy Trauma. A minimum 5 year follow-up

Hohmann, Erik; Wansbrough, Guy; Senewiratne, Serene; Tetsworth, Kevin

doi:10.1016/j.injury.2016.05.020

Cited by 10 publications

(11 citation statements)

References 34 publications

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“…Hohmann et al reported three of his four patients has returned to work and sporting activity with a median range of motion from 5-95 degrees. 14 The practice and training of orthopaedic in Malaysia are different from most developed countries. In the United Kingdom, for example, a gastrocnemius flap can only be performed by a plastic surgeon because an orthopaedic surgeon does not have adequate training in this procedure.…”

Section: Discussionmentioning

confidence: 99%

Revisiting the Pedicled Gastrocnemius Flap for Orthoplastic Limb Reconstruction

Yusof

Alwi

2021

imjm

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INTRODUCTION: Gastrocnemius muscle flap is performed in a combined approach of the orthopaedic and plastic team for limb reconstruction in the developed countries. However, this practice is not readily available in Malaysia because of the smaller numbers of plastic surgery services in government hospitals. This study reviews the outcome of the gastrocnemius flap performed by the orthopaedic team. MATERIALS AND METHODS: Thirty-two patients underwent gastrocnemius flap surgery with a mean age of 35.3 years (range 13-82). The flaps were done to cover the upper third (22), upper half (4), knee (2), distal femur (2) and the popliteal fossa (1). The initial problems were open fracture (21), infection following plating (5), necrotising fasciitis (3), degloving injury (1), pin site infection (1) and melioidosis (1). Five patients were having underlying Diabetes mellitus, 3 Hepatitis B, 2 HIV and 1 Hepatitis C infections. RESULTS: There was no flap necrosis. Complications include persistence infection in 3 patients which required advancement of the flap (1) and additional fasciocutaneous flap (2) to cover the wound breakdown. All fractures achieved union but one patient with infection following double plating for tibial plateau fracture developed chronic osteomyelitis. One patient develops transient peroneal nerve palsy following the lateral gastrocnemius transfer. Both patients who had patella ligament reconstruction with gastrocnemius flap develop knee stiffness. CONCLUSIONS: Gastrocnemius flap is a reliable and safe procedure in salvaging the leg from amputation related to open fractures and infections in orthopaedic surgery. It should be one of the options for the operative procedure thought during the orthopaedic training.

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Section: Discussionmentioning

confidence: 99%

Revisiting the Pedicled Gastrocnemius Flap for Orthoplastic Limb Reconstruction

Yusof

Alwi

2021

imjm

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“…Eighteen studies 13,14,[17][18][19][20][21][22][23][24]28,30,33,34 provided information on postoperative rehabilitation following extensor mechanism reconstruction using local flaps. In most cases, patients were placed in either a splint or cast to maintain strict knee immobilization in full extension.…”

Section: Postoperative Carementioning

confidence: 99%

A Systematic Review of Clinical Outcomes of Pedicled Flap Repairs of the Knee Extensor Mechanism

Lee,

Fisher,

McNamara

et al. 2024

J Reconstr Microsurg

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Background Rupture of the extensor mechanism of the knee has severe functional morbidity, and repair can be complicated by infection, allograft degeneration, and recurrent rupture. Techniques of autologous tissue repair utilizing pedicled flaps such as the gastrocnemius offer vascularized methods of reconstruction, with potentially diminished complication rates. The goal of this study was to evaluate the functional outcomes and complications associated with pedicled flap repair of the knee extensor mechanism. Methods A systematic review was conducted following PRISMA guidelines. Publications that focused on local myocutaneous flaps as a means for reconstruction were included. Causes for knee extensor mechanism deficit, flap characteristics, ambulation rate, changes in range of motion pre- and post-operation, and postoperative complications were analyzed. Technique reports including primary suture repairs, synthetic mesh, and allograft use were excluded. Results An initial 119 studies were identified, with final review of 22 observational studies encompassing 128 cases of pedicled flap reconstructions. The gastrocnemius (88.2%, n=113), quadriceps (6.3%, n=8), and a combination of the vastus and gastrocnemius flaps (5.5%, n=7), were the most frequently utilized flaps. Functional outcomes were favorable with 87.2% of patients achieving ambulation without external support. Variability in range of motion outcomes across different flap may be secondary to the patient characteristics as well as extent of initial injury. Conclusions Autologous pedicle flap reconstruction of the knee extensor mechanism emerges as a viable option for cases characterized by extensive defects and insufficient soft tissue coverage, which are not amenable to direct suture repairs or allografts. Postoperative assessments revealed that the majority of patients experienced improved ambulation status, with no instances of deterioration noted among the patients.

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“…Free muscle ap such as latissimus dorsi and gracilis muscle aps has been reported as a reliable alterative approach for reconstruction of the complex tissue defect in the knee region, because of its rich blood supply and large area. 15,16 Those advantages are speci cally indicated more complex soft defects with joint and/or prosthesis exposure. However, problems of donor-site morbidity and bulkiness of aps remain.…”

Section: Disscusionmentioning

confidence: 99%

Customized Reconstruction of Complex Soft Tissue Defect Around the Knee with Individual Design of Free Perforator Flap

Fu¹,

Qing²,

Wu³

et al. 2020

Preprint

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Background Reconstruction of complex soft tissue defect around the knee, particularly in involving with large soft tissue defect or disruption of extensor mechanism, always is a challenging problem. The purpose of this study was to introduce our clinical experience on using individual design of free perforator flap for complex soft-tissue reconstruction around the knee. Methods Between June 2010 and March 2017, 16 patients underwent the reconstruction of complex soft tissue defect in the knee region with free perforator flap, Various flap designs was performed basing on the location of wound, the require pedicle length, the tissue components that are deficient, the volume of such components and the risk of donor site morbidity.Results Complex soft tissue defect of the knee was reconstructed with anteriorlateral thigh perforator (ALTP) flap in 5 cases, modified ALTP flap in 2 cases, chimeric ALTP flap in 4 cases, dual skin paddles ALTP flap in 2 cases and chimeric thoracodorsal artery perforator (TDAP) flap in 2 cases. Multiple perforator flaps and vascularized fascia lata in combination were performed in one case. All flaps survived postoperative. None vascular congestion was observed. Only one case suffered partial necrosis. Primary closure of donor site was performed for all patients. The mean follow-up time was 16.5 months. Most cases showed satisfactory flap contour and acceptable function outcome. Conclusions Free perforator flap is a reliable option for repairing complex soft tissue defect in the knee region, especially when local and pedicled flaps are unavailable. Various flap designs allow for more individualized treatment approaches.

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Medial Gastrocnemius Flap for Reconstruction of the Extensor Mechanism of the Knee Following High-Energy Trauma. A minimum 5 year follow-up

Abstract: Introduction:

Cited by 10 publications

References 34 publications

Revisiting the Pedicled Gastrocnemius Flap for Orthoplastic Limb Reconstruction

Revisiting the Pedicled Gastrocnemius Flap for Orthoplastic Limb Reconstruction

A Systematic Review of Clinical Outcomes of Pedicled Flap Repairs of the Knee Extensor Mechanism

Customized Reconstruction of Complex Soft Tissue Defect Around the Knee with Individual Design of Free Perforator Flap

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