Introduction To treat severe soft-tissue complications of total knee arthroplasty, we used an extended reversed gracilis flap based on secondary pedicles (the GReSP flap).
Step 1: Prepare Wound BedLocate the gracilis and pedicles, then debride the wound bed.
Step 2: Expose Gracilis MuscleExpose the superficial aspect of the muscle, while protecting the saphenous vein and nerve.
Step 3: Check Muscle PerfusionTemporarily clamp the main vascular pedicle to ensure blood supply when perfused only by the secondary pedicles.
Step 4: Mobilize Muscle FlapTransect the proximal tendon of the gracilis muscle to provide maximal length for the muscle flap and ligate the main vascular and nerve pedicles.
Step 5: Cover with Skin GraftSuture the flap in place and cover with skin graft.
Step 6: Postoperative CareImmobilize the knee for two weeks; follow with rehabilitation to restore range of motion.
Results & Preop./Postop. Images We treated three patients who had an infection at the site of a total knee arthroplasty and exposure of the implant.
What to Watch For Indications
Pitfalls & Challenges
Figures in this Article
To treat severe soft-tissue complications of total knee arthroplasty, we used an extended reversed gracilis flap based on secondary pedicles (the GReSP flap).
Soft-tissue reconstruction of the anterior aspect of the knee requires restoration of pliable and gliding tissues for satisfactory recovery of knee motion. Local fasciocutaneous rotation flaps, distally based anterolateral thigh flaps, or more recent fasciocutaneous free-style perforator flaps are often insufficient techniques because of multiple scars on the lateral and medial surfaces of the knee caused by previous operations1,2. We are aware of only sporadic reports of free tissue transfers for patients with an infection at the site of a megaprosthesis of the knee3. Medial and lateral gastrocnemius transposition flaps remain the most useful …
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