Medial Gastrocnemius Flap in the Course of Treatment for an Infection at the Site of a Total Knee Arthroplasty

While there are many reasons the medial gastrocnemius flap is often the favored treatment for soft tissue defects around the knee area, this flap has some disadvantages. Reduced volume at the distal part of the flap and a short reach complicate provision of sufficient coverage for soft tissue defects superior to the patella and the lateral knee. In order to overcome these shortcomings, we modified the typical surgical technique by combining a medial gastrocnemius muscle flap and a medial sural artery perforator flap. This approach was applied to four patients who had developed deep infections and skin and soft tissue defects around the knee joint after total knee arthroplasty. The surgeries were successful. Dead space was well-filled and wounds healed without complications in all patients. This modified medial gastrocnemius myocutaneous flap provides a new option for treating challenging skin and soft tissue defects caused by deep infection after total knee arthroplasty.

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THE MEDIAL GASTROCNEMIUS MUSCLE FLAP IN THE TREATMENT OF WOUND COMPLICATIONS FOLLOWING TOTAL KNEE ARTHROPLASTY

Orthopedics ◽

10.3928/0147-7447-19920401-14 ◽

1992 ◽

Vol 15 (4) ◽

pp. 477-480

Author(s):

Edward S Hemphill ◽

Frank R Ebert ◽

Alan G Muench

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Gastrocnemius Muscle ◽

Muscle Flap ◽

Medial Gastrocnemius ◽

Wound Complications ◽

Total Knee ◽

Medial Gastrocnemius Muscle

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Pedicled Gastrocnemius Flap in Complicated Total Knee Arthroplasty

Scandinavian Journal of Surgery ◽

10.1177/145749690309200208 ◽

2003 ◽

Vol 92 (2) ◽

pp. 156-159 ◽

Cited By ~ 9

Author(s):

A. Papp ◽

J. Kettunen ◽

H. Miettinen

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Gastrocnemius Flap ◽

Total Knee

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Autologous Patellar Tendon Reconstruction after Total Knee Arthroplasty Infection with Skin Loss: Anatomical Study and Case Report

The Journal of Knee Surgery ◽

10.1055/s-0038-1677498 ◽

2019 ◽

Vol 33 (02) ◽

pp. 173-179

Author(s):

Alberto Pérez-García ◽

Juan Ramon Esteban-Vico ◽

Jose María García-Sánchez ◽

José Baeza ◽

Francisco Martínez Soriano ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Patellar Tendon ◽

Knee Arthroplasty ◽

Anatomical Study ◽

Lower Limbs ◽

Medial Gastrocnemius ◽

Skin Defect ◽

Fresh Cadaver ◽

Extensor Apparatus ◽

Total Knee

AbstractDisruption of patellar tendon after total knee arthroplasty (TKA) is a devastating complication. If associated with infection or soft tissue defect, knee arthrodesis is usually indicated. The purpose of this study is to analyze, by means of an anatomical study, the feasibility of our novel technique for reconstruction of extensor apparatus after TKA infections with skin defects, combining gracilis (G) and semitendinosus (ST) tendon autografts and chimeric medial gastrocnemius-sural artery perforator (SAP) flap. In addition, to report on the use of this reconstruction, we described an illustrative clinical case. Ten fresh cadaver lower limbs were dissected. The width of the gastrocnemius, number of medial SAP, length of hamstrings tendons, and distance from the lower pole of the patella to anterior tibial tuberosity (ATT) were measured. A mean of 1.37 perforator branches (range 1–3) was found. In all cases, the tendon length for gracilis and ST, and the width in the middle third of gastrocnemius related to the patella-ATT distance were enough to make the reconstruction. We performed this technique in a 78-year-old man with an infected TKA with skin defect. After 1 year and two-stage procedure, the patient achieved full active knee extension and was able to ambulate without aids. Extensor apparatus reconstruction combining tendon autografts and chimeric medial gastrocnemius-SAP flap is an available technique and may be considered as an alternative to arthrodesis in extensor mechanism ruptures after infection in TKA.

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