Archives of Plastic Surgery

  • 제50권6호
  • /
  • Pages.593-600
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  • 2023
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  • 2234-6163(pISSN)
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  • 2234-6171(eISSN)
대한성형외과학회 (Korean Society of Plastic and Reconstructive Surgeons)
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Role of the Gastrocnemius Musculocutaneous with a Propeller Style Skin Flap in Knee Region Reconstruction: Indications and Pitfalls

  • Gianluca Sapino (Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV)) ;
  • Rik Osinga (Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel) ;
  • Michele Maruccia (Department of Plastic and Reconstructive Surgery, University Hospital of Bari) ;
  • Martino Guiotto (Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV)) ;
  • Martin Clauss (Department of Orthopedic and Trauma Surgery, University Hospital of Basel) ;
  • Olivier Borens (Department of Orthopedic Surgery, Centre Hospitalier Universitaire Vaudois (CHUV)) ;
  • David Guillier (Department of Plastic Reconstructive and Hand Surgery, Department of Oral and Maxillofacial Surgery, University Hospital) ;
  • Pietro Giovanni di Summa (Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV))
  • 투고 : 2022.08.26
  • 심사 : 2023.02.15
  • 발행 : 2023.11.15
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초록

Background Soft tissue reconstruction around the knee area is still an open question, particularly in persistent infections and multiple reoperations scenario. Flap coverage should guarantee jointmobility and protection, even when foreign materials are implanted. The chimeric harvesting of the musculocutaneous gastrocnemius flap, based on the sural artery perforators, can extend its applicability in soft tissue reconstruction of the upper leg, overcoming the drawbacks of the alternative pedicled flaps. Methods A multicenter retrospective study was conducted enrolling patients who underwent to a pedicled, chimeric gastrocnemius musculocutaneous-medial sural artery perforator (GM-MSAP) or lateral sural artery perforator (GM-LSAP) flap for knee coverage in total knee arthroplasty (TKA) recurrent infections and oncological or traumatic defects of the upper leg from 2018 to 2021. Outcomes evaluated were the successful soft tissue reconstruction and flap complications. Surgical timing, reconstruction planning, technique, and rehabilitation protocols were discussed. Results Twenty-one patients were included in the study. Nineteen GM-MSAPs and 2 GM-LSAPs were performed (soft tissue reconstruction in infected TKA [12], in infected hardware [4], and in oncological patients [5]). Donor site was closed primarily in 9 cases, whereas a skin graft was required in 12. Flap wound dehiscence (1), distal flap necrosis (1), distal necrosis of the skin paddle (1), and donor site infection (1) were the encountered complications. Flap reraise associated to implant exchange or extensive debridement was successful without requiring any further flap surgery. Conclusion The propeller-perforator GM-MSAP offers qualitative defect coverage and easiness of multiple flap reraise due to skin availability and its laxity.

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참고문헌

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