Benedict Katherine C, Wegener Brown Kathryn, Barr Jennifer S, McIntyre Benjamin C
Division of Plastic and Reconstructive Surgery, University of Mississippi Medical Center, Jackson, MS.
Department of Orthopedic Surgery, University of Mississippi Medical Center, Jackson, MS.
Plast Reconstr Surg Glob Open. 2022 Feb 9;10(2):e4107. doi: 10.1097/GOX.0000000000004107. eCollection 2022 Feb.
Coverage of knee wounds with exposure or violation of the joint capsule has long been a challenge to plastic surgeons. Wide resection and radiation treatment for soft-tissue sarcomas further this difficulty due to resultant diminished vascularity and soft tissue fibrosis. Traditional muscle flaps such as the gastrocnemius may be within the radiated field, limiting their arc of rotation to the knee. We present a series of exposed knee joint reconstructions using pedicled propeller flaps after sarcoma resection. Three patients diagnosed with soft tissue sarcomas underwent neoadjuvant radiation followed by wide local resection by orthopedic oncology. All patients had underlying knee joint exposure and underwent successful soft tissue reconstruction utilizing pedicled anterolateral thigh (ALT) propeller flaps. The ALT flap is widely used in plastic surgery for reconstruction of soft tissue defects due to its reliable vascularity, long pedicle, versatility, low donor-site morbidity, and large size. As a propeller flap, we demonstrate this is a viable alternative for reconstruction when the vascular plexus around the knee is unreliable after neoadjuvant radiation. Extending the ALT propeller flap with a large proximal skin paddle provides a nonmicrosurgical alternative to traditional muscle flaps at this location. The ALT propeller flap is an excellent option for reconstruction of large defects of the knee, especially in the setting of a radiated wound bed with unpredictable vascularity. In our case series, all three patients underwent successful reconstruction of exposed knee joints after resection of soft tissue sarcoma utilizing ALT propeller flaps.
膝关节伤口伴有关节囊暴露或破损,长期以来一直是整形外科医生面临的挑战。软组织肉瘤的广泛切除和放射治疗会进一步加剧这一难题,因为这会导致血管减少和软组织纤维化。传统的肌皮瓣,如腓肠肌瓣,可能处于放射野内,限制了其在膝关节处的旋转弧度。我们展示了一系列在肉瘤切除术后使用带蒂推进皮瓣进行膝关节暴露重建的病例。三名被诊断为软组织肉瘤的患者接受了新辅助放疗,随后由骨肿瘤外科进行广泛局部切除。所有患者均存在膝关节暴露情况,并利用带蒂股前外侧(ALT)推进皮瓣成功进行了软组织重建。ALT皮瓣因其可靠的血供、长蒂、多功能性、供区并发症少以及面积大等优点,在整形外科中广泛用于软组织缺损的重建。作为推进皮瓣,我们证明当新辅助放疗后膝关节周围血管丛不可靠时,它是一种可行的重建替代方案。通过一个大的近端皮瓣延长ALT推进皮瓣,为该部位的传统肌皮瓣提供了一种非显微外科的替代方法。ALT推进皮瓣是重建膝关节大缺损的极佳选择,尤其是在伤口床接受过放疗且血管情况不可预测的情况下。在我们的病例系列中,所有三名患者在软组织肉瘤切除术后利用ALT推进皮瓣成功重建了暴露的膝关节。