Use of Posterior Calf Fascial Flap: A New Concept for the Management of Knee Contracture With Unstable Scar

Prakash, Vishwa; Mishra, Anuj

doi:10.1097/00006534-200301000-00109

Cited by 4 publications

(7 citation statements)

References 2 publications

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“…The mean age at the time of incisional release and grafting was 7.64 years (range, [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. At surgery, a transverse incision is made on the distal thigh in an area of tightness determined and marked at preoperative evaluation with the knee joint maximally flexed.…”

Section: Resultsmentioning

confidence: 99%

“…All the knee ulcers closed spontaneously within an average of 28 days (range, 21-56 days) postincisional release and grafting. The mean follow-up period was 5.05 years (range, [1][2][3][4][5][6][7][8][9][10][11] with no evidence of recurrence.…”

Section: Resultsmentioning

confidence: 99%

“…1 The traditional treatment approach most often used has been to excise the ulcer and either close the defect primarily or resurface the area with a split-thickness skin grafts. 1,5,10 In either case, skin tightness around the knee joint is not addressed and if significant may continue to inhibit a favorable outcome. Achauer and Vanderkam 5 described unstable scar of the anterior knee in a burn patient as a primary reconstructive problem in which coverage with skin graft may be too thin, leading to unstable correction.…”

Section: Discussionmentioning

confidence: 99%

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Management of Postburn Recalcitrant Knee Ulcers in Pediatric Patients

Dhanraj

Asuku

et al. 2004

The Journal of Burn Care &Amp; Rehabilitation

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The sequelae of severe lower-extremity burn injuries in children include ulcerations and unstable scars of the anterior knee. Although the weight-bearing and ambulatory demands on this joint predispose the ulcers to chronicity, recalcitrance to treatment in the absence of systemic factors may be indicative of the presence of less-than-optimal local factors mitigating against healing. In our experience, excessive skin tightness around the knee joint has played a key role in this respect. This retrospective study on 10 patients with 16 recalcitrant knee ulcers demonstrated the inadequacy of the traditional treatment approach of ulcer excision and grafting. However, incisional release of tight skin above the knee joint and resurfacing the defect with split-thickness skin graft (mean size, 118.26 +/- 35.32 cm2) eliminated excessive tension and allowed the ulcers to heal spontaneously and permanently. We found this approach useful in select patients, and we are favorably disposed to additional releasing incision and grafting if the need arises in the growing child.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Management of Postburn Recalcitrant Knee Ulcers in Pediatric Patients

Dhanraj

Asuku

et al. 2004

The Journal of Burn Care &Amp; Rehabilitation

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“…Yildirim et al reported that the front of the thigh flap can be used in covering skin and soft tissue burned joint stiffness after surgery [5]. Prakash used the posterior leg fascia flap to resolve the knee skin scarring tension [6,7]. The Z plasty is also recommended by surgeons [19].…”

Section: Discussionmentioning

confidence: 99%

“…The treatment of the skin is very tricky in knee release surgery because of varying degrees of scar contracture. Most surgeons adopt skin grafting to solve the shortage of skin during the joint release surgery [4][5][6][7]. However, its disadvantages are clear, such as limited donor and new intra-articular adhesions by breaks in the skin graft.…”

Section: Introductionmentioning

confidence: 99%

Treatment and Rehabilitation of Knee Joints Straight Stiffness After Burns

Tang

et al. 2014

Indian J Surg

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The knee release surgery and postoperative rehabilitation of patients after burns and knee straight stiffness were investigated. Eleven patients were treated for 16 side burns and knee stiffness who consisted of nine males and two females, aged 19 to 54 years (mean=33.2). The duration of the patients' knee stiffness ranged from 8 to 26 months, with an average of 12.6 months. Their preoperative flexion ranged from 5°to 50°, with an average of 26.2°. Their preoperative Hospital for Special Surgery (HSS) knee scores ranged from 46 to 72 points, with an average of 55.8 points. All stiff knees were treated with release surgery, along with total release of intra-articular adhesion and excision of vastus intermedius. After the arthrolysis of the stiff knee joint, the tight skin was completely loose in the adhesions. The soft tissue contracture was not grafted, but the shade fascia was freed to increase skin ductility. All knee joints were released to more than 90°of flexion in the operation, and reversed fascia flaps were used to suture the loss of the deep fascia at the position of flexion of 90°. After the operation, the knee joint was fixed in flexion for 72 h while being actively cared for by early rehabilitation. Subsequently, the patient's skin coverage, joint motion, and joint function recovery were observed. Based on the followup of the patients for the following 16 to 36 months (mean= 25.7), the knee flexion of the patients ranged from 110°to 135°, with an average of 122.2°and 96°increase (P<0.01). Furthermore, the patients had better skin ductility to meet the increase in joint flexion. HSS knee function scores at the end of follow-up ranged from 93 to 100 points, with an average of 97.5 points and an increase of 41.7 points (P<0.01). The joint function improved significantly. The arthrolysis of straight stiff knee joints after burns can ease muscle contracture and free the shade fascia, thus avoiding the need to undergo skin grafting. Short-term fixation of the joints after surgery and active flexion rehabilitation may also be the key to improve skin ductility and joint function of the patients.

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