Prefabricated Muscle Flap for Difficult wound Around the Knee Joint

ABSTRACT

The reconstruction of soft tissue defects with open fracture around the knee joint is limited by its unique location. Free tissue transfer is hindered by the selection of the recipient vessel and problems of microsurgery. The arc of rotation, defect size, and location must be taken into consideration in the use of regional muscle transfer such as gastrocnemius. According to Mathes et al, the flap survival can be enhanced by selective division of the dominant segmental pedicles, only a part of which can normally be transposed safely on its minor segmental pedicle. Neovascularization, vascular proliferation, and dilatation have also been produced by the delay procedure using silicone sheets. The authors have used the delay procedures with wrapping of the gracilis or sartorius muscle which enabled distally-based transposition of these muscles. The method showed satisfactory outcome in resurfacing the wound around the knee joint. The indictions for this procedure were defects of moderate size and those difficult to reach with conventional muscle flaps. The flap could reach the upper one-third of the lower leg. Other merits are relative simplicity and reliability without significant extension of hospital stay. The drawbacks are the two operative procedures necessary and the risk of infection due to silicone sheets.