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CC BY 4.0 · Arch Plast Surg 2023; 50(06): 593-600
DOI: 10.1055/s-0043-1768644
Extremity/Lymphedema
Original Article

Role of the Gastrocnemius Musculocutaneous with a Propeller Style Skin Flap in Knee Region Reconstruction: Indications and Pitfalls

Gianluca Sapino    *
1   Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
,
Rik Osinga    *
2   Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland
,
Michele Maruccia 
3   Department of Plastic and Reconstructive Surgery, University Hospital of Bari, Bari, Italy
,
Martino Guiotto 
1   Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
,
Martin Clauss 
4   Department of Orthopedic and Trauma Surgery, University Hospital of Basel, Basel, Switzerland
,
Olivier Borens 
5   Department of Orthopedic Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
,
David Guillier 
6   Department of Plastic Reconstructive and Hand Surgery, Department of Oral and Maxillofacial Surgery, University Hospital, Dijon, France
,
Pietro Giovanni di Summa
1   Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
› Author Affiliations Funding None.
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Abstract

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 joint mobility 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.

Keywords

musculocutaneous gastrocnemius flap - medial sural artery perforator gastrocnemius flap - GM-MSAP - knee reconstruction - upper leg soft tissue reconstruction

Authors' Contribution

S.G., O.R. and P.G.diS.: idea and writing.

M.M.: concept and proof reading.

G.M.: database and writing.

C.M., B.O., and G.D.: proof reading and idea.


Ethical Approval

Local ethical committee approval was obtained (no.: 2022-00434) for this study.


Patient Consent

Written and informed patient consent was obtained for publication and academic purpose.


* Authors share co-first authorship.




Publication History

Received: 26 August 2022

Accepted: 15 February 2023

Article published online:
24 August 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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