Soft-Tissue Reconstruction of the Complicated Knee Arthroplasty: Principles and Predictors of Salvage

Colen, David L.; Carney, Martin J.; Shubinets, Valeriy; Lanni, Michael A.; Liu, Tiffany; Levin, L. Scott; Lee, Gwo-Chin; Kovach, Stephen J.

doi:10.1097/prs.0000000000004255

Cited by 24 publications

(47 citation statements)

References 22 publications

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“…For this reason, newly fasciocutaneous perforator flaps have been proposed also for the peri‐knee reconstruction because of their flexibility and lower donor site morbidity (A. Gravvanis et al, ). Recently Colen modified the knee reconstructive ladder and according to his data, local fasciocutaneous flaps are the first line in soft tissue knee coverage, followed by local muscle flaps, while free flap reconstruction should be considered as the last choice (Colen et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, local complications after total knee arthroplasty may cause exposure of the implant (A. Gravvanis et al, ). In those cases or in all the cases involving the exposure of the patella and the tendons, the defect requires early flap coverage, in order to preserve joint mobility and prevent major infections resulting in even amputation (Colen et al, ; H. P. Zheng, Lin, Zhuang, & Zhang, ). Thin, pliable, well‐vascularized tissues are mandatory to restore the aesthetic appearance of the knee and facilitate the joint function (Fang et al, ; Osei, Rebehn, & Boyer, ; H. Zheng, Wang, Zhang, & Yue, ).…”

Section: Introductionmentioning

confidence: 99%

“…Gravvanis et al, 2014). In those cases or in all the cases involving the exposure of the patella and the tendons, the defect requires early flap coverage, in order to preserve joint mobility and prevent major infections resulting in even amputation (Colen et al, 2018;H. P. Zheng, Lin, Zhuang, & Zhang, 2012).…”

Section: Introductionmentioning

confidence: 99%

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Lower medial thigh perforator (LMTP) propeller flap for reconstruction of soft tissue defects around the knee

et al. 2019

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Background Skin and soft‐tissue defects around the knee are common and their reconstruction is still challenging and argued. Thin, pliable and well‐vascularized tissues are required in order to restore the aesthetic appearance of the knee and facilitate joint function. Historically local muscle flaps were employed for the upper third of the lower limb reconstruction; however, since their introduction, different perforator flaps have been proposed for this purpose. The aim of this report is to share our clinical experience with the pedicled lower medial thigh perforator (p‐LMT) flap for the reconstruction of skin and soft tissue defects around the knee. Patients and Methods Between August 2013 and July 20, 2018, patients underwent pedicled LMT propeller flap reconstruction for defects around the knee. The subunits of the defects were the suprapatellar, the infrapatellar and patellar area and in two cases a full around the knee defect was reported. Cause of defects included trauma (13), tumor (4) and infection after knee operation (3) and defect sizes ranged from 4 × 3 cm2 to 7 × 8 cm2. Results Flap sizes ranged from 4 × 9 cm2 to 6 × 16 cm2. One to two perforators based on the superficial femoral artery or descending genicular artery were found between the septum of satorius and vastus medialis, or piercing the vastus medialis during dissection. All flaps were rotated 180° in propeller fashion. All the donor sites were primarily closed and no complication at the donor site was detected. In the two cases of the total knee soft tissue defect, a double pedicled flaps reconstruction was required. After a 6 months follow‐up, all the patients in the series achieved a full range of motion. Conclusions Fasciocutaneous flaps are currently the first reconstructive option for the soft tissue defects around the knee. The p‐LMT flap reconstruction in this case series achieved good aesthetic and functional outcomes and this flap may be a valuable option for the reconstruction of the small to medium soft tissue defects around the knee.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Lower medial thigh perforator (LMTP) propeller flap for reconstruction of soft tissue defects around the knee

et al. 2019

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Section: Original Researchmentioning

confidence: 99%

“…The Medial Sural Artery Perforator Island Flap as a Simpler Alternative for Prophylactic Skin Augmentation Prior to Total Knee Arthroplasty Geoffrey G. Hallock *, † Total knee arthroplasty is a common orthopaedic procedure of great benefit in restoring unimpeded and pain free ambulation with rare complications [1]. However, subsequent soft tissue compromise and/or joint infection can be disastrous if prosthesis salvage is impossible requiring instead knee fusion or even amputation [1]. The pre-operative presence of tenuous soft tissues, most obvious if a skin graft covers the knee region; or the existence of multiple or problematic scars should be indications for consideration of prophylactic soft tissue replacement with a flap so as to avoid these endpoints [1,2].…”

Section: Original Researchmentioning

confidence: 99%

The Medial Sural Artery Perforator Island Flap as a Simpler Alternative for Prophylactic Skin Augmentation Prior to Total Knee Arthroplasty

Hallock¹

2019

International Journal of Orthoplastic Surgery

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Surgical Anatomy At the very least, the medial sural artery perforator [MSAP] flap will capture the skin territory overlying the medial gastrocnemius muscle. The medial sural artery is the source vessel to that muscle as it is to this flap; and is a branch of the popliteal artery, originating at or about the knee joint [4]. After entering the undersurface of the muscle, most commonly the medial sural artery bifurcates to run superficial [posterior] or deep within the muscle surface [5]. Although the distribution of major medial sural artery musculocutaneous perforators that can sustain this flap can be quite variable [6-9], almost always at least a single such perforator can be found [6]. On average, these can be found 13 ± 2 cm. below the popliteal crease, and 2.5 ± 1 cm from the posterior midline (Figure 1) [5]; but in reality can emanate anywhere from within the medial gastrocnemius muscle. The actual possible pedicle to practically sustain an island MSAP flap depends on the location of the perforator, and can range in length from 9-16 cm [5]. Venous outflow parallels the course of the perforators. As an island flap this will usually be insensate. Since in the lower extremity interconnections between perforasomes are oriented in a longitudinal direction [11], the major axis of any MSAP flap should also parallel that pattern to

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From replantation to transplantation: The evolution of orthoplastic extremity reconstruction

Levin

2022

Journal Orthopaedic Research

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For more than six decades, the use of the operating microscope for extremity surgery has led to remarkable advances in the management of orthopedic trauma, tumors, infections, and congenital differences. The microsurgical reconstructive ladder ascends from basic microsurgical procedures such as a digital artery or nerve repair to more complex procedures such as autologous tissue transplantation. Functional muscle transfers, toe-to-hand transfers, and recently vascularized composite allotransplantation are the highest rungs on this ladder that help restore extremity function. The development of the orthoplastic approach over the last three decades simultaneously integrates the principles and practices of both orthopedic surgery and plastic surgery for optimal care and salvage of extremities. Clinical, anatomic, and basic science research in reconstructive microsurgery has resulted in significant improvements in extremity salvage, reconstruction, and restoration.

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Soft-Tissue Reconstruction of the Complicated Knee Arthroplasty: Principles and Predictors of Salvage

Abstract: Therapeutic, III.

Cited by 24 publications

References 22 publications

Lower medial thigh perforator (LMTP) propeller flap for reconstruction of soft tissue defects around the knee

Lower medial thigh perforator (LMTP) propeller flap for reconstruction of soft tissue defects around the knee

The Medial Sural Artery Perforator Island Flap as a Simpler Alternative for Prophylactic Skin Augmentation Prior to Total Knee Arthroplasty

From replantation to transplantation: The evolution of orthoplastic extremity reconstruction

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