Abstract
Background
Adequate coverage of the knee region is often challenging for plastic and orthopedic surgeons. In the last decade, among several reconstructive techniques, local perforator flaps have become useful reconstructive units. After a wide resection for soft-tissue sarcoma, the knee vascular web may be reasonably damaged and, consequently, perforator flaps based on a local pedicle [such as the distally based anterolateral thigh (ALT) flap] are not reliable. Thus, we harvested a proximally based ALT for knee coverage.
Methods
A 52-year-old man underwent local radiation therapy and a wide resection of a soft-tissue sarcoma on the anterior-lateral aspect of the left knee, which resulted in a 15 × 10 cm defect. The defect was covered with a proximally based ALT, through an advancement and propeller relocation of its skin paddle.
Results
All margins were tumor free. After 5 days, the donor site was closed primarily because of edema. Neither necrosis of the flap nor dehiscence of the wound was detected. No local relapses were detected at 6-month follow-up.
Conclusions
In case of soft-tissue defects of the knee region, with likely involvement of the local vascular web, a local perforator solution is the advancement and propeller proximally based ALT flap.
Level of Evidence V
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References
Singer S, Demetri GD, Baldini EH, Fletcher CD (2000) Management of soft-tissue sarcomas: an overview and update. Lancet Oncol 1:75–85
My Nahabedian, Mont MA, Orlando JC, Delanois RE, Hungerford DS (1999) Operative management and outcome of complex wounds following total knee artroplasty. Plast Reconstr Surg 104:1688–1697
Vaienti L, Marchesi A, Palitta G, Gazzola R, Parodi PC, Leone F (2013) Limb trauma: the use of an advanced wound care device in the treatment of full-thickness wounds. Strategies Trauma Limb Reconstr 8(2):111–115
Fang T, Zhang EW, Lineaweaver WC, Zhang F (2013) Recipient vessels in the free flap reconstruction around the knee. Ann Plast Surg 71(4):429–433
Louer CR, Garcia RM, Earle SA, Hollenbeck ST, Erdmann D, Levin LS (2015) Free flap reconstruction of the knee: an outcome study of 34 cases. Ann Plast Surg 74(1):57–63
Yildirim S, Avci G, Akan M, Misirlioğlu A, Aköz T (2003) Anterolateral thigh flap in the treatment of postburn flexion contractures of the knee. Plast Reconstr Surg 111:1630–1637
Chen CY, Chen CYHsieh CH, Kuo YR, Jeng SF (2007) An anterolateral thigh perforator flap from the ipsilateral thigh for soft-tissue reconstruction around the knee. Plast Reconstr Surg 120(2):470–473
Siebert C, Höfler HR, Bruns J, Hansis M (1996) Reversed musculus biceps femoris flap for covering a defect of the distal thigh. Chirurg 67(11):1188–1192
Pozzobon LR, Helito CP, Guimarães TM, Gobbi RG, Pécora JR, Camanho GL (2013) Rotation flaps for coverage after total knee arthroplasty. Acta Ortop Bras 21(4):219–222
Vaienti L, Menozzi A, Lonigro J, Soresina M, Ravasio G (2010) The salvage of knee-exposed prosthesis using neurofasciocutaneous sural flap. Musculoskelet Surg 94(1):33–40
Suri MP, Friji MT, Ahmad QG et al (2010) Utility of proximally based sural artery flap for lower thigh and knee defects. Ann Plast Surg 64:462–465
Tos P, Innocenti M, Artiaco S, Antonini A, Delcroix L, Geuna S, Battiston B (2011) Perforator-based propeller flaps treating loss of substance in the lower limb. J Orthopaed Traumatol 12:93–99
Vaienti L, Calori GM, Leone F, Brioschi M, Parodi PC, Marchesi A (2014) Posterior tibial artery perforator flaps for coverage of Achilles region defects. Injury 45(Suppl 6):S133–S137
Koshima I, Nanba Y, Tsutsui T, Takahashi Y, Itoh S (2002) Perforator flaps in lower extremity reconstruction. Handchir Mikrochir Plast Chir 34:251–256
Fujiwara T, Chen CC, Ghetu N, Jeng SF, Kuo YR (2010) Antegrade anterolateral thigh perforator flap advancement for soft-tissue reconstruction of the knee: case report. Microsurgery 30(7):549–552
Zhang G (1990) Reversed anterolateral thigh island flap and myocutaneous flap transplantation. Zhonghua Yi Xue Za Zhi 70(676–8):46
Pan SC, Yu JC, Shieh SJ, Lee JW, Huang BM, Chiu HY (2004) Distally based anterolateral thigh flap: an anatomic and clinical study. Plast Reconstr Surg 114:1768–1775
Cotrufo S, Hart A (2010) A note of caution on the use of the distally based anterolateral thigh flap: anatomical evidence. Plast Reconstr Surg 125:30e–31e
Giunta RE, Geisweid A, Feller A (2000) The value of preoperative doppler sonography for planning free perforator flaps. Plast Reconstr Surg 105:2381–2386
Erba P, Raffoul W, Bauquis O (2012) Safe dissection of the distally based anterolateral thigh flap. J Reconstr Microsurg 28:405–412
Gravvanis AI, Iconomou TG, Panayotou PN, Tsoutsos DA (2005) Medial gastrocnemius muscle flap versus distally based anterolateral thigh flap: conservative or modern approach to the exposed knee joint? Plast Reconstr Surg 116:932–934
Liu TY, Jeng SF, Yang JC, Shih HS, Chen CC, Hsieh CH (2010) Reconstruction of the skin defect of the knee using a reverse anterolateral thigh island flap: cases report. Ann Plast Surg 64(2):198–201
Wong CH, Goh T, Tan BK, Ong YS (2013) The anterolateral thigh perforator flap for reconstruction of knee defects. Ann Plast Surg 70(3):337–342
Lin SJ, Rabie A, Yu P (2010) Designing the anterolateral thigh flap without preoperative Doppler or imaging. J Reconstr Microsurg 26(1):67–72
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Cadenelli, P., Bordoni, D., Radaelli, S. et al. Proximally Based Anterolateral-Thigh (ALT) Flap for Knee Reconstruction: An Advancement Propeller Perforator Flap. Aesth Plast Surg 39, 752–756 (2015). https://doi.org/10.1007/s00266-015-0536-2
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DOI: https://doi.org/10.1007/s00266-015-0536-2