[Patellar tendon reconstruction using iliotibial tract graft and gastrocnemius pedicled flap, a case report].

Large substance loss of the patellar tendon is rare and thus its treatment does not benefit from a consensus. These tendon destructions associated with a vast loss of substance in the surrounding soft tissues make reconstruction a dual challenge because tendon reconstruction and skin coverage must be achieved at the same time. The precocity of the repair and the use of autologous tissue appear to be the determining factors for recovery of the knee function at term. They seem to be independent of the technique used. We report the case of a 36-year-old patient who was diagnosed with purpura fulminans due to strep throat. She was taking non-steroidal anti-inflammatory drugs. The case was complicated by extensive necrosis of the extremities that necessitated a quadruple amputation, notably on the lower extremity: trans femoral on the left and trans tibial on the right. For functional reasons it was imperative to keep the knee straight despite the exposure of the entire extensor system, precarious bone vitality of the patella and necrosis of the patellar tendon. The therapeutic objective was to cover the entire extensor system and reconstruct the patellar tendon by combining the ipsilateral iliotibial tract band and the medial gastrocnemius pedicled flap. At six months follow-up, active flexion and extension of the knee allows walking with suitable prosthetics and without crutches.