CC BY-NC-ND 4.0 · Indian J Plast Surg 2014; 47(02): 221-226
DOI: 10.4103/0970-0358.138954
Original Article
Association of Plastic Surgeons of India

Inferiorly based thigh flap for reconstruction of defects around the knee joint

Md. Sohaib Akhtar
1   Post Graduate Department of Burns, Plastic and Reconstructive Surgery, JNMC, AMU, Aligarh, Uttar Pradesh, India
,
Arshad Hafeez Khan
1   Post Graduate Department of Burns, Plastic and Reconstructive Surgery, JNMC, AMU, Aligarh, Uttar Pradesh, India
,
Mohammed Fahud Khurram
1   Post Graduate Department of Burns, Plastic and Reconstructive Surgery, JNMC, AMU, Aligarh, Uttar Pradesh, India
,
Imran Ahmad
1   Post Graduate Department of Burns, Plastic and Reconstructive Surgery, JNMC, AMU, Aligarh, Uttar Pradesh, India
› Institutsangaben
Weitere Informationen

Address for correspondence:

Dr. Md. Sohaib Akhtar
Post Graduate, Department of Burns, Plastic and Reconstructive Surgery
JNMC, AMU, Aligarh, Uttar Pradesh
India   

Publikationsverlauf

Publikationsdatum:
26. August 2019 (online)

 

ABSTRACT

Background: Soft-tissue defects around the knees are common in injured limbs and in the same injury the leg is often involved and the thigh is spared. Furthermore due to pliable and relatively lax skin, we have used inferiorly based thigh flap to reconstruct defects around knee joint. Aims and Objectives: The aim of this study is to evaluate the use of inferiorly based thigh flap to cover soft-tissue defects over the proximal one-third of the leg, patellar region, knee, and lower thigh. Materials and Methods: This study was conducted during the period between October 2011 and February 2013. Inferiorly based anteromedial thigh fasciocutaneous flap was performed on 12 patients and inferiorly based anterolateral thigh fasciocutaneous flap on four patients. The sites of the soft-tissue defects included patellar regions, infrapatellar region, upper one-third of leg, lower thigh, and over the knee joint. Results: Patients were evaluated post-operatively in terms of viability of flap, the matching of the flap with the recipient site, and donor site morbidity. All the flaps survived well except one which developed distal marginal flap loss, one in which wound dehiscence was noticed, and two in which mild venous congestion was observed. Venous congestion in two patients subsided on its own within 3 days. One patient with wound dehiscence achieved complete healing by secondary intention. Patient who developed distal flap loss required debridement and skin grafting. No appreciable donor site morbidity was encountered. Skin colour and texture of the flap matched well with the recipient site. Conclusions: The inferiorly based thigh flap is a reliable flap to cover the defect over proximal one-third of the leg, patellar region, knee, and lower thigh.


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Conflicts of interest

None declared.

  • REFERENCES

  • 1 Misra A, Niranjan NS. Fasciocutaneous flaps based on fascial feeder and perforator vessels for defects in the patellar and peripatellar regions. Plast Reconstr Surg 2005; 115: 1625-32
  • 2 Ries MD, Bozic KJ. Medial gastrocnemius flap coverage for treatment of skin necrosis after total knee arthroplasty. Clin Orthop Relat Res 2006; 446: 186-92
  • 3 Satoh K, Fukuya F, Matsui A, Onizuka T. Lower leg reconstruction using a sural fasciocutaneous flap. Ann Plast Surg 1989; 23: 97-103
  • 4 Torii S, Hayashi Y, Hasegawa M, Sugiura S. Reverse flow saphenous island flap in the patient with below-knee amputation. Br J Plast Surg 1989; 42: 517-20
  • 5 Lu LJ, Feng B, Gong X, Wang k, Liu Z, Wang D. Clinical study on retrograde fascial flap with a pedicle of supragenicular cutaneous artery arising from saphenous artery. Chin J Microsurg 2004; 27: 10-2
  • 6 Hayashi A, Maruyama Y. The lateral genicular artery flap. Ann Plast Surg 1990; 24: 310-7
  • 7 Hayashi A, Maruyama Y. Lateral intermuscular septum of the thigh and short head of the biceps femoris muscle: An anatomic investigation with new clinical applications. Plast Reconstr Surg 2001; 108: 1646-54
  • 8 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: 15-20
  • 9 Sobotta J. Atlas De Anatomia Humana. 19 th ed.. Rio de Janeiro: Guanabara Koogan; 1993. -p. 70, 71, 77, 203, 364
  • 10 Hallock GG. Local knee random fasciocutaneous flaps. Ann Plast Surg 1989; 23: 289-96
  • 11 Necmioglu S, Askar I, Lök V, Subasi M. Use of the vastus lateralis muscle flap with a grooving procedure in the surgical treatment of chronic osteomyelitis of the femur. Ann Plast Surg 2004; 53: 570-6
  • 12 Gravvanis AI, Iconomou TG, Panayotou PN, Tsoutsos DA. Medial gastrocnemius muscle flap versus distally based anterolateral thigh flap: Conservative or modern approach to the exposed knee joint?. Plast Reconstr Surg 2005; 116: 932-4
  • 13 Umemoto Y, Adachi Y, Ebisawa K. The sural artery perforator flap for coverage of defects of the knee and tibia. Scand J Plast Reconstr Surg Hand Surg 2005; 39: 209-12
  • 14 Hallock GG. The medial sural (Medial Gastrocnemius) perforator local flap. Ann Plast Surg 2004; 53: 501-5
  • 15 Sharma RK, Nanda V, Makkar S, Parasher A. De-epithelialised fasciocutaneous turnover flap: An alternative for defects in lower thigh and knee joint. Indian J Plast Surg 2004; 37: 40
  • 16 Chen CY, Hsieh CH, Kuo YR, Jeng SF. An anterolateral thigh perforator flap from the ipsilateral thigh for soft-tissue reconstruction around the knee. Plast Reconstr Surg 2007; 120: 470-3
  • 17 Moscatiello F, Masià J, Carrera A, Clavero JA, Larrañaga JR, Pons G. The ′propeller′ distal anteromedial thigh perforator flap. Anatomic study and clinical applications. J Plast Reconstr Aesthet Surg 2007; 60: 1323-30
  • 18 Lu LJ, Gong X, Cui JL, Liu B. The anteromedial thigh fasciocutaneous flap pedicled on the supragenicular septocutaneous perforator: Application in 11 patients. Ann Plast Surg 2011; 67: 275-8
  • 19 Chou LS, Chang KC, Lin TW, Chou HC. Distally based anteromedial thigh fasciocutaneous island flap for patellar soft tissue reconstruction. J Trauma 2009; 66: 1146-51
  • 20 Lin SD, Lai CS, Chiu CC. Venous drainage in the reverse forearm flap. Plast Reconstr Surg 1984; 74: 508-12
  • 21 Zumiotti AV, Teng HW, Briceno NCQ, Lotierzo PH, Ishida LH, Montag E. et al. Lateral flap of the thigh based upon the lateral superior genicular artery: An anatomic and histomorphometric study and clinical applications. Acta Ortop Bras 2005; 13: 24
  • 22 Al Moktader MA, Hassan M, Taman E, Taha A, Elawa S. Lateral superior genicular flap for reconstruction around the knee. Egypt J Plast Reconstr Surg 2010; 34: 223-6
  • 23 Zhang G. Reversed anterolateral thigh island flap and myocutaneous flap transplantation. Zhonghua Yi Xue Za Zhi 1990; 70: 676-8 46
  • 24 Taniguchi Y, Kitano T, Shimoe T, Asai Y, Yoshida M. Superior lateral genicular artery flap for coverage of a soft tissue defect after total knee arthroplasty. J Reconstr Microsurg 2009; 25: 479-82
  • 25 Zhang Q, Qiao Q, Yang X, Wang H, Robb GL, Zhou G. Clinical application of the anterolateral thigh flap for soft tissue reconstruction. J Reconstr Microsurg 2010; 26: 87-94
  • 26 Hong JP, Shin HW, Kim JJ, Wei FC, Chung YK. The use of anterolateral thigh perforator flaps in chronic osteomyelitis of the lower extremity. Plast Reconstr Surg 2005; 115: 142-7

Address for correspondence:

Dr. Md. Sohaib Akhtar
Post Graduate, Department of Burns, Plastic and Reconstructive Surgery
JNMC, AMU, Aligarh, Uttar Pradesh
India   

  • REFERENCES

  • 1 Misra A, Niranjan NS. Fasciocutaneous flaps based on fascial feeder and perforator vessels for defects in the patellar and peripatellar regions. Plast Reconstr Surg 2005; 115: 1625-32
  • 2 Ries MD, Bozic KJ. Medial gastrocnemius flap coverage for treatment of skin necrosis after total knee arthroplasty. Clin Orthop Relat Res 2006; 446: 186-92
  • 3 Satoh K, Fukuya F, Matsui A, Onizuka T. Lower leg reconstruction using a sural fasciocutaneous flap. Ann Plast Surg 1989; 23: 97-103
  • 4 Torii S, Hayashi Y, Hasegawa M, Sugiura S. Reverse flow saphenous island flap in the patient with below-knee amputation. Br J Plast Surg 1989; 42: 517-20
  • 5 Lu LJ, Feng B, Gong X, Wang k, Liu Z, Wang D. Clinical study on retrograde fascial flap with a pedicle of supragenicular cutaneous artery arising from saphenous artery. Chin J Microsurg 2004; 27: 10-2
  • 6 Hayashi A, Maruyama Y. The lateral genicular artery flap. Ann Plast Surg 1990; 24: 310-7
  • 7 Hayashi A, Maruyama Y. Lateral intermuscular septum of the thigh and short head of the biceps femoris muscle: An anatomic investigation with new clinical applications. Plast Reconstr Surg 2001; 108: 1646-54
  • 8 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: 15-20
  • 9 Sobotta J. Atlas De Anatomia Humana. 19 th ed.. Rio de Janeiro: Guanabara Koogan; 1993. -p. 70, 71, 77, 203, 364
  • 10 Hallock GG. Local knee random fasciocutaneous flaps. Ann Plast Surg 1989; 23: 289-96
  • 11 Necmioglu S, Askar I, Lök V, Subasi M. Use of the vastus lateralis muscle flap with a grooving procedure in the surgical treatment of chronic osteomyelitis of the femur. Ann Plast Surg 2004; 53: 570-6
  • 12 Gravvanis AI, Iconomou TG, Panayotou PN, Tsoutsos DA. Medial gastrocnemius muscle flap versus distally based anterolateral thigh flap: Conservative or modern approach to the exposed knee joint?. Plast Reconstr Surg 2005; 116: 932-4
  • 13 Umemoto Y, Adachi Y, Ebisawa K. The sural artery perforator flap for coverage of defects of the knee and tibia. Scand J Plast Reconstr Surg Hand Surg 2005; 39: 209-12
  • 14 Hallock GG. The medial sural (Medial Gastrocnemius) perforator local flap. Ann Plast Surg 2004; 53: 501-5
  • 15 Sharma RK, Nanda V, Makkar S, Parasher A. De-epithelialised fasciocutaneous turnover flap: An alternative for defects in lower thigh and knee joint. Indian J Plast Surg 2004; 37: 40
  • 16 Chen CY, Hsieh CH, Kuo YR, Jeng SF. An anterolateral thigh perforator flap from the ipsilateral thigh for soft-tissue reconstruction around the knee. Plast Reconstr Surg 2007; 120: 470-3
  • 17 Moscatiello F, Masià J, Carrera A, Clavero JA, Larrañaga JR, Pons G. The ′propeller′ distal anteromedial thigh perforator flap. Anatomic study and clinical applications. J Plast Reconstr Aesthet Surg 2007; 60: 1323-30
  • 18 Lu LJ, Gong X, Cui JL, Liu B. The anteromedial thigh fasciocutaneous flap pedicled on the supragenicular septocutaneous perforator: Application in 11 patients. Ann Plast Surg 2011; 67: 275-8
  • 19 Chou LS, Chang KC, Lin TW, Chou HC. Distally based anteromedial thigh fasciocutaneous island flap for patellar soft tissue reconstruction. J Trauma 2009; 66: 1146-51
  • 20 Lin SD, Lai CS, Chiu CC. Venous drainage in the reverse forearm flap. Plast Reconstr Surg 1984; 74: 508-12
  • 21 Zumiotti AV, Teng HW, Briceno NCQ, Lotierzo PH, Ishida LH, Montag E. et al. Lateral flap of the thigh based upon the lateral superior genicular artery: An anatomic and histomorphometric study and clinical applications. Acta Ortop Bras 2005; 13: 24
  • 22 Al Moktader MA, Hassan M, Taman E, Taha A, Elawa S. Lateral superior genicular flap for reconstruction around the knee. Egypt J Plast Reconstr Surg 2010; 34: 223-6
  • 23 Zhang G. Reversed anterolateral thigh island flap and myocutaneous flap transplantation. Zhonghua Yi Xue Za Zhi 1990; 70: 676-8 46
  • 24 Taniguchi Y, Kitano T, Shimoe T, Asai Y, Yoshida M. Superior lateral genicular artery flap for coverage of a soft tissue defect after total knee arthroplasty. J Reconstr Microsurg 2009; 25: 479-82
  • 25 Zhang Q, Qiao Q, Yang X, Wang H, Robb GL, Zhou G. Clinical application of the anterolateral thigh flap for soft tissue reconstruction. J Reconstr Microsurg 2010; 26: 87-94
  • 26 Hong JP, Shin HW, Kim JJ, Wei FC, Chung YK. The use of anterolateral thigh perforator flaps in chronic osteomyelitis of the lower extremity. Plast Reconstr Surg 2005; 115: 142-7