Reconstruction of massive knee defects with extensor mechanism deficiency through concurrent anterolateral thigh flap and autogenous hamstring tendon: A report of two cases

Abstract

Reconstruction of an infected knee joint with a large defect and extensor mechanism deficiency is challenging. In this study, we aim to describe a one-stage reconstruction surgery and provide its surgical outcome. Two patients had patellar open fracture and subsequent septic arthritis; in addition, a large soft tissue defect, loss of patella, and shortening of the patellar tendon were observed. The semitendinosus–gracilis tendon formed a loop to stabilize the patella. A free or supercharged reverse pedicle myocutaneous anterolateral thigh flap with fascial extension is designed to fill the defect and eradicate the infection. Mean clinical follow-up was 18 months. Although some limitation in the knee range of motion was observed, the dynamometer showed only partial loss in peak concentric power and eccentric power. We developed an innovative surgical procedure to alleviate infection and reconstruct a complex knee defect with extensor mechanism deficiency; this procedure resulted in favorable clinical outcomes.

Reconstruction of chronic tibialis anterior tendon ruptures using a free anterior half of a peroneus longus tendon autograft: A technical note

“…4 A delay in the diagnosis of TA tendon rupture may result in a major tendon defect, making a direct repair no longer suitable. 5,6 Several techniques have been introduced to reconstruct the TA tendon rupture, which include the use of an allograft tendon, an autogenous tendon such as the EDL, plantaris or hamstring tendons, or an EHL tendon transfer. [1][2][3][4]7,8 Although satisfactory clinical outcomes have been reported with the use of an autogenous tendon, there is still a possibility of donor site morbidity after full-thickness tendon harvest.…”

Reconstruction of a knee defect in a morbidly obese patient with a pedicled reverse anterolateral thigh flap

“…Pedicled flaps originating from the thigh, such as the reverse vastus lateralis muscle or the reverse anterolateral thigh (ALT) flaps, can be used for coverage of the knee. These options provide reliable donor tissue in close proximity to the defect, reducing surgical trauma and the risk of complications as well as operative time, compared with a free flap 5–7…”

“…In obese patients, the risk of flap necrosis and donor site complications is significantly increased 10 11. To enhance the reliability of the dbALT flap and to avoid reverse venous blood flow, venous supercharging has been suggested 1 5 10…”