Outcomes of the gastrocnemius flap performed by orthopaedic surgeons in salvage revision knee arthroplasty

Introduction: The gastrocnemius myofascial flap is used to manage soft-tissue defects over the anterior aspect of the knee in the context of a patient presenting with a sinus and periprosthetic joint infection (PJI) or extensor mechanism failure. The aim of this study was twofold: firstly, to evaluate the outcomes of gastrocnemius flaps performed by appropriately trained orthopaedic surgeons in the context of PJI and, secondly, to evaluate the infection-free survival of this patient group. Patients and methods: We retrospectively reviewed 30 patients who underwent gastrocnemius flap reconstruction during staged revision total knee arthroplasty for prosthetic joint infection (PJI). All flaps were performed by an orthopaedic surgeon with orthoplastics training. Patients had a mean age of 68.9 years (range 50–84) and were followed up for a mean of 50.4 months (range 2–128 months). A total of 29 patients (97 %) were categorized into Musculoskeletal Infection Society (MSIS) local extremity grade 3 (greater than two compromising factors), and 52 % of PJIs were polymicrobial. The primary outcome measure was flap failure, and the secondary outcome measure was recurrent infection. Results: Flap survival was 100 % with no failures or early returns to theatre for flap problems such as necrosis or haematoma. Overall infection-free survival during the study period was 48 % (13 of 27 infected cases). Using limb salvage as the outcome, 77 % (23 of 30 patients) retained the limb. Infection recurrence occurred in 48 % (10 patients) in the type B3 cohort and 67 % (4 patients) in the type C3 cohort (p=0.65). Conclusions: The surgical technique for a gastrocnemius myofascial flap is reliable and reproducible when performed by appropriately trained orthopaedic surgeons, even in high-risk groups. However, the risks of recurrent infection and amputation remain high within our series due to poor host and extremity factors.

Revisiting the Pedicled Gastrocnemius Flap for Orthoplastic Limb Reconstruction

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.

Medial Gastrocnemius Flap for Covering Tissue Defects Around the Knee

Summary. Tissue defects of the anterior surface of the lower leg and the knee joint is a severe problem at the treatment of orthopedic patients. Objective. Analysis of the results of using the medial gastrocnemius flap (MGF) in orthopedic patients; highlighting peculiarities of surgical technique. Materials and Methods. 8 patients (10 cases) who underwent the transposition of the MGF. The age of the patients was 19–74 years (on average 40.5±5.7 years); there were 6 males and 2 females. The list of cases: open fractures – 2 cases, combat injury – 2 patients (3 cases), skin necrosis after osteosynthesis – 3 patients (4 cases), and skin necrosis after total knee replacement – 1 case. The results of treatment were assessed in terms 9 months – 10 years by the Lysholm scale. Results. Autodermoplasty during MGF transposition was performed in two cases and after a few days in others. In cases with open fractures, the osteosynthesis and external fixators reassembly were done; conversion of osteosynthesis was performed one month after autodermoplasty. In cases of skin necrosis after osteosynthesis and total arthroplasty, the implants were never removed. Knee function according to the Lysholm scale ranged from 70 to 100 points (mean 88.2±3.3). Conclusions. The transposition of the MGF for the replacement of tissue defects of the anterior surface of the lower leg and knee joint is an effective method in orthopedic surgery, which helps to solve the problem of infectious complications and to save the supporting-kinematic function of the lower extremity.