Muscle-only versus chimeric musculocutaneous gastrocnemius pedicled flap in complex orthoplastic reconstructions of the knee region: A retrospective study

• Published in: Journal of plastic, reconstructive & aesthetic surgery Vol. 77; pp. 298 - 308
• Main Authors: Sapino, G., Guiller, D., Osinga, R., Martineau, J., De Santis, G., Steinmetz, S., di Summa, P.G.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.02.2023
• Subjects: Gastrocnemius muscle flap; GM-MSAP; Humans; Knee defects; Lower limb reconstruction; Muscle, Skeletal - transplantation; Pedicled chimeric musculocutaneous medial sural artery perforator flap; Perforator Flap - blood supply; Plastic Surgery Procedures; Postoperative Complications - surgery; Retrospective Studies; Soft Tissue Injuries - surgery; Surgical Flaps - blood supply; Treatment Outcome; GM-MSAP; Knee defects; Lower limb reconstruction; Gastrocnemius muscle flap; Pedicled chimeric musculocutaneous medial sural artery perforator flap
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2022.12.006

The knee region represents a challenging area of soft tissue reconstruction. Specifically, in the context of total knee arthroplasty (TKA) or following high-energy trauma with fractures and hardware fixation, soft tissue defects can expose critical structures such as joint, bone or tendon, besides the implant/plates themselves, with dramatic consequences in terms of postoperative infection and hardware contamination. A retrospective study was conducted on a prospectively maintained database from January 2016 to February 2021. Inclusion criteria involved all patients who underwent an implant-associated infection of the knee and upper third of the leg coupled with a soft tissue reconstruction (STR) using the traditional gastrocnemius muscle (GM) pedicled flap or the chimeric GM-MSAP (medial sural artery perforator) flap. Thirty-eight patients were included (group A, GM flap, 22 patients; group B, chimeric GM-MSAP flap, 16 patients). No statistically significant differences were detected in terms of age, comorbidities, defect size, follow-up, and flap complications. A statistically significant difference was seen among the groups in terms of successful flap re-raise (required because of a persistent infection of the implant or in a two-stage procedure setting, including the use of a cemented spacer) in favour of the GM-MSAP group. The chimeric GM-MSAP, being safer to reraise if required, can be a significantly more powerful tool in those cases in which a two-stage procedure is planned or when there is a high probability for secondary intervention need, reducing the need to convert to either free flap coverage or amputation.