RESEARCH PROGRESS OF SOFT TISSUE DEFECT REPAIR AROUND THE KNEE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Jie , LU Lixuan , JIANG Hua.

Department of Plastic Surgery, Shanghai Changzheng Hospital, Shanghai, 200003, P.R.China. Corresponding author: JIANG Hua, E-mail: dosjh@126.com;

Corresponding author：

Keywords：

Soft tissue defect around the knee; Fascial flap; Myocutaneous flap; Wound repair

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Objective To review the research progress of the skin flap, fascial flap, muscle flap, and myocutaneous flap for repairing soft tissue defects around the knee so as to provide information for clinical application. Methods Domestic and abroad literature concerning the methods of soft tissue repair around the knee in recent years was reviewed extensively and analyzed. Results Fascial flaps meet the requirements of thin, pliable, and tough skin in the soft tissue repair around the knee. Myocutaneous flaps and muscle flaps have more abundant blood supply and anti-infection function. Free skin flaps are the only option when defects are extensive and local flaps are unavailable. Conclusion Suitable flaps should be chosen for soft tissue repair around the knee according to defect position, depth, and extent. Fascial flaps may be selected as the first flaps for defects repair because of excellent aesthetic results and less injury at the donor site.

Citation： ZHANG Jie,LU Lixuan,JIANG Hua.. RESEARCH PROGRESS OF SOFT TISSUE DEFECT REPAIR AROUND THE KNEE. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(9): 1138-1141. doi: Copy

1.	Panni AS, Vasso M, Cerciello S, et al. Wound complications in total knee arthroplasty. Which flap is to be used? With or without retention of prosthesis? Knee Surg Sports Traumatol Arthrosc, 2011, 19(7): 1060-1068.
2.	Manoso MW, Boland PJ, Healey JH, et al. Limb salvage of infected knee reconstructions for cancer with staged revision and free tissue transfer. Ann Plast Surg, 2006, 56(5): 532-535.
3.	Barfod B, Pers M. Gastrocnemius-plasty for primary closure of compound injuries of the knee. J Bone Joint Surg (Br), 1970, 52(1): 124-127.
4.	Veber M, Vaz G, Braye F, et al. Anatomical study of the medial gastrocnemius muscle flap: a quantitative assessment of the arc of rotation. Plast Reconstr Surg, 2011, 128(1): 181-187.
5.	Casanova D, Hulard O, Zalta R, et al. Management of wounds of exposed or infected knee prostheses. Scand J Plast Reconstr Surg Hand Surg, 2001, 35(1): 71-77.
6.	Boopalan PR, Nithyananth M, Jepegnanam TS. Lateral gastrocnemius flap cover for distal thigh soft tissue loss. J Trauma, 2010, 69(5): E38-41.
7.	Busfield BT, Huffman GR, Nahai F, et al. Extended medial gastrocnemius rotational flap for treatment of chronic knee extensor mechanism deficiency in patients with and without total knee arthroplasty. Clin Orthop Relat Res, 2004, (428): 190-197.
8.	Patel NS, Ibrahim DT, Finn HA. Knee extensor mechanism reconstruction with medial gastrocnemius flap. Clin Orthop Relat Res, 2002, (398): 176-181.
9.	Ries MD, Bozic KJ. Medial gastrocnemius flap coverage for treatment of skin necrosis after total knee arthroplasty. Clin Orthop Relat Res, 2006, (446): 186-192.
10.	Tiengo C, Macchi V, Vigato E, et al. Reversed gracilis pedicle flap for coverage of a total knee prosthesis. J Bone Joint Surg (Am), 2010, 92(7): 1640-1646.
11.	McCraw JB, Fishman JH, Sharzer LA. The versatile gastrocnemius myocutaneous flap. Plast Reconstr Surg, 1978, 62(1): 15-23.
12.	Ger R. Closure of defects of the lower extremity by muscle flaps//Converse JM. Reconstructive plastic surgery. Philadelphia: WB Saunders Company, 1977: 3558.
13.	Fayman MS, Orak F, Hugo B, et al. The distally based split soleus muscle flap. Br J Plast Surg, 1987, 40(1): 20-26.
14.	Zheng H, Wang H, Zhang F, et al. Anatomic basis of perforator flaps of medial vastus muscle. Microsurgery, 2007, 28(1): 61-64.
15.	Siebert CH, Höfler HR, Bruns J, et al. Reversed musculus biceps femoris flap for covering a defect of the distal thigh. Chirurg, 1996, 67(11): 1188-1192.
16.	Nguyen AT, Wong C, Mojallal A, et al. Lateral supragenicular pedicle perforator flap: clinical results and vascular anatomy. J Plast Reconstr Aesthet Surg, 2011, 64(3): 381-385.
17.	Hayashi A, Maruyama Y. The lateral genicular artery flap. Ann Plast Surg, 1990, 24(4): 310-317.
18.	Spokevicius S, Jankauskas A. Anatomy and clinical applications of a composite cutaneo-subcutaneous flap based on the lateral superior genicular vessels. J Reconstr Microsurg, 1995, 11(1): 15-20.
19.	Wiedner M, Koch H, Scharnagl E. The superior lateral genicular artery flap for soft-tissue reconstruction around the knee: clinical experience and review of the literature. Ann Plast Surg, 2011, 66(4): 388-392.
20.	徐达传, 钟世镇, 刘牧之, 等. 股前外侧部皮瓣的解剖学: 一个新的游离皮瓣供区. 临床应用解剖学杂志, 1984, 2(3): 158-160.
21.	罗力生, 高建华, 陈林峰, 等. 股前外侧皮瓣及其游离移植的应用. 第一军医大学学报, 1984, 4(1、2): 1-4.
22.	Kim JS, Lee HS, Jang PY, et al. Use of the descending branch of lateral circumflex femoral artery as a recipient pedicle for coverage of a knee defect with free flap: anatomical and clinical study. Microsurgery, 2010, 30(1): 32-36.
23.	Shieh SJ, Chiu HY, Yu JC. Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation. Plast Reconstr Surg, 2000, 105(7): 2349-2360.
24.	Pan SC, Yu JC, Shieh SJ, et al. Distally based anterolateral thigh flap: an anatomic and clinical study. Plast Reconstr Surg, 2004, 114(7): 1768-1775.
25.	Wang XC, Lu Q, Li XF, et al. Reversed anterolateral thigh adipofascial flap for knee and proximal calf defects. Burns, 2008, 34(6): 868-872.
26.	Liu TY, Jeng SF, Yang JC, et al. Reconstruction of the skin defect of the knee using a reverse anterolateral thigh island flap: case report. Ann Plast Surg, 2010, 64(2): 198-201.
27.	Demirseren ME, Efendioglu K, Demiralp CO, et al. Clinical experience with a reverse-flow anterolateral thigh perforator flap for the reconstruction of soft-tissue defects of the knee and proximal lower leg. J Plast Reconstr Aesthet Surg, 2011, 64(12): 1613-1620.
28.	Hallock GG. The medial sural (MEDIAL GASTROCNEMIUS) perforator local flap. Ann Plast Surg, 2004, 53(5): 501-505.
29.	Kim HH, Jeong JH, Seul JH, et al. New design and identiflcation of the medial sural perforator flap: an anatomical study and its clinical applications. Plast Reconstr Surg, 2006, 117(5): 1609-1618.
30.	Shim JS, Kim HH. A novel reconstruction technique for the knee and upper one third of lower leg. J Plast Reconstr Aesthet Surg, 2006, 59(9): 919-926.
31.	Cheon SJ, Kim IB, Park WR, et al. The proximally-based sural artery flap for coverage of soft tissue defects around the knee and on the proximal third and middle third of the lower leg: 10 patients followed for 1-2.5 years. Acta Orthop, 2008, 79(3): 370-375.
32.	Park S, Eom JS. Selection of the recipient vessel in the free flap around the knee: the superior medial genicular vessels and the descending genicular vessels. Plast Reconstr Surg, 2001, 107(5): 1177-1182.
33.	Beumer JD, Karoo R, Caplash Y, et al. The medial sural artery as recipient vessel and the impact on the medial gastrocnemius. Ann Plast Surg, 2011, 67(4): 382-386.
34.	Hong JP, Koshima I. Using perforators as recipient vessels (supermicrosurgery) for free flap reconstruction of the knee region. Ann Plast Surg, 2010, 64(3): 291-293.

1. Panni AS, Vasso M, Cerciello S, et al. Wound complications in total knee arthroplasty. Which flap is to be used? With or without retention of prosthesis? Knee Surg Sports Traumatol Arthrosc, 2011, 19(7): 1060-1068.
2. Manoso MW, Boland PJ, Healey JH, et al. Limb salvage of infected knee reconstructions for cancer with staged revision and free tissue transfer. Ann Plast Surg, 2006, 56(5): 532-535.
3. Barfod B, Pers M. Gastrocnemius-plasty for primary closure of compound injuries of the knee. J Bone Joint Surg (Br), 1970, 52(1): 124-127.
4. Veber M, Vaz G, Braye F, et al. Anatomical study of the medial gastrocnemius muscle flap: a quantitative assessment of the arc of rotation. Plast Reconstr Surg, 2011, 128(1): 181-187.
5. Casanova D, Hulard O, Zalta R, et al. Management of wounds of exposed or infected knee prostheses. Scand J Plast Reconstr Surg Hand Surg, 2001, 35(1): 71-77.
6. Boopalan PR, Nithyananth M, Jepegnanam TS. Lateral gastrocnemius flap cover for distal thigh soft tissue loss. J Trauma, 2010, 69(5): E38-41.
7. Busfield BT, Huffman GR, Nahai F, et al. Extended medial gastrocnemius rotational flap for treatment of chronic knee extensor mechanism deficiency in patients with and without total knee arthroplasty. Clin Orthop Relat Res, 2004, (428): 190-197.
8. Patel NS, Ibrahim DT, Finn HA. Knee extensor mechanism reconstruction with medial gastrocnemius flap. Clin Orthop Relat Res, 2002, (398): 176-181.
9. Ries MD, Bozic KJ. Medial gastrocnemius flap coverage for treatment of skin necrosis after total knee arthroplasty. Clin Orthop Relat Res, 2006, (446): 186-192.
10. Tiengo C, Macchi V, Vigato E, et al. Reversed gracilis pedicle flap for coverage of a total knee prosthesis. J Bone Joint Surg (Am), 2010, 92(7): 1640-1646.
11. McCraw JB, Fishman JH, Sharzer LA. The versatile gastrocnemius myocutaneous flap. Plast Reconstr Surg, 1978, 62(1): 15-23.
12. Ger R. Closure of defects of the lower extremity by muscle flaps//Converse JM. Reconstructive plastic surgery. Philadelphia: WB Saunders Company, 1977: 3558.
13. Fayman MS, Orak F, Hugo B, et al. The distally based split soleus muscle flap. Br J Plast Surg, 1987, 40(1): 20-26.
14. Zheng H, Wang H, Zhang F, et al. Anatomic basis of perforator flaps of medial vastus muscle. Microsurgery, 2007, 28(1): 61-64.
15. Siebert CH, Höfler HR, Bruns J, et al. Reversed musculus biceps femoris flap for covering a defect of the distal thigh. Chirurg, 1996, 67(11): 1188-1192.
16. Nguyen AT, Wong C, Mojallal A, et al. Lateral supragenicular pedicle perforator flap: clinical results and vascular anatomy. J Plast Reconstr Aesthet Surg, 2011, 64(3): 381-385.
17. Hayashi A, Maruyama Y. The lateral genicular artery flap. Ann Plast Surg, 1990, 24(4): 310-317.
18. Spokevicius S, Jankauskas A. Anatomy and clinical applications of a composite cutaneo-subcutaneous flap based on the lateral superior genicular vessels. J Reconstr Microsurg, 1995, 11(1): 15-20.
19. Wiedner M, Koch H, Scharnagl E. The superior lateral genicular artery flap for soft-tissue reconstruction around the knee: clinical experience and review of the literature. Ann Plast Surg, 2011, 66(4): 388-392.
20. 徐达传, 钟世镇, 刘牧之, 等. 股前外侧部皮瓣的解剖学: 一个新的游离皮瓣供区. 临床应用解剖学杂志, 1984, 2(3): 158-160.
21. 罗力生, 高建华, 陈林峰, 等. 股前外侧皮瓣及其游离移植的应用. 第一军医大学学报, 1984, 4(1、2): 1-4.
22. Kim JS, Lee HS, Jang PY, et al. Use of the descending branch of lateral circumflex femoral artery as a recipient pedicle for coverage of a knee defect with free flap: anatomical and clinical study. Microsurgery, 2010, 30(1): 32-36.
23. Shieh SJ, Chiu HY, Yu JC. Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation. Plast Reconstr Surg, 2000, 105(7): 2349-2360.
24. Pan SC, Yu JC, Shieh SJ, et al. Distally based anterolateral thigh flap: an anatomic and clinical study. Plast Reconstr Surg, 2004, 114(7): 1768-1775.
25. Wang XC, Lu Q, Li XF, et al. Reversed anterolateral thigh adipofascial flap for knee and proximal calf defects. Burns, 2008, 34(6): 868-872.
26. Liu TY, Jeng SF, Yang JC, et al. Reconstruction of the skin defect of the knee using a reverse anterolateral thigh island flap: case report. Ann Plast Surg, 2010, 64(2): 198-201.
27. Demirseren ME, Efendioglu K, Demiralp CO, et al. Clinical experience with a reverse-flow anterolateral thigh perforator flap for the reconstruction of soft-tissue defects of the knee and proximal lower leg. J Plast Reconstr Aesthet Surg, 2011, 64(12): 1613-1620.
28. Hallock GG. The medial sural (MEDIAL GASTROCNEMIUS) perforator local flap. Ann Plast Surg, 2004, 53(5): 501-505.
29. Kim HH, Jeong JH, Seul JH, et al. New design and identiflcation of the medial sural perforator flap: an anatomical study and its clinical applications. Plast Reconstr Surg, 2006, 117(5): 1609-1618.
30. Shim JS, Kim HH. A novel reconstruction technique for the knee and upper one third of lower leg. J Plast Reconstr Aesthet Surg, 2006, 59(9): 919-926.
31. Cheon SJ, Kim IB, Park WR, et al. The proximally-based sural artery flap for coverage of soft tissue defects around the knee and on the proximal third and middle third of the lower leg: 10 patients followed for 1-2.5 years. Acta Orthop, 2008, 79(3): 370-375.
32. Park S, Eom JS. Selection of the recipient vessel in the free flap around the knee: the superior medial genicular vessels and the descending genicular vessels. Plast Reconstr Surg, 2001, 107(5): 1177-1182.
33. Beumer JD, Karoo R, Caplash Y, et al. The medial sural artery as recipient vessel and the impact on the medial gastrocnemius. Ann Plast Surg, 2011, 67(4): 382-386.
34. Hong JP, Koshima I. Using perforators as recipient vessels (supermicrosurgery) for free flap reconstruction of the knee region. Ann Plast Surg, 2010, 64(3): 291-293.

Chinese Journal of Reparative and Reconstructive Surgery

RESEARCH PROGRESS OF SOFT TISSUE DEFECT REPAIR AROUND THE KNEE

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