G Sapino1, P Zaugg2, S Cherix3, O Borens3, S J Lo4, W Raffoul2, P G di Summa5. 1. Department of Plastic and Reconstructive Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, CH, Switzerland; Department of Plastic and Reconstructive Surgery, Policlinico Universitario di Modena, Modena, IT, Italy. 2. Department of Plastic and Reconstructive Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, CH, Switzerland. 3. Department of Orthopaedic Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, CH, Switzerland. 4. Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow, UK. 5. Department of Plastic and Reconstructive Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, CH, Switzerland; Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow, UK. Electronic address: pietro.di-summa@chuv.ch.
Abstract
INTRODUCTION: Composite anterolateral thigh (ALT) flap with vascularized fascia lata can reconstitute patellar tendon integrity and knee soft tissue coverage in one stage. However, long-term evidence of outcomes is lacking. This work analyzes long-term functional results, compares subtotal and total reconstruction of patellar tendon, and assesses the respective function of the extensor apparatus. PATIENTS AND METHODS: Outcomes of reconstruction using 10 ALT flaps in 9 patients (age range 21-87 years) were analyzed (mean follow-up 30 ± 6 months). Knee Society Scores, isometric knee extensor strength (M1-M5), and sensory recovery were evaluated, together with active range of motion and extensor lag of the reconstructed limb, compared to contralateral. RESULTS: Ten flaps were used for tendon replacement in 9 patients. Eight (80%) free flaps and 2 (20%) propeller distally based flaps were used. Complications requiring the harvest of a second flap were seen in 2 patients. All patients could return to their daily activities without the use of walking supports. Mean active ROM was 94.4° with an extensor lag of 9.4°, without a significant difference between partial and total patellar tendon reconstruction. The mean knee and functional scores of the Knee Society were 81/100 and 77/100, respectively. CONCLUSION: Composite ALT flap with fascia lata can satisfy the twofold needs of functional restoration and soft tissue coverage, thus ensuring stable results in total and subtotal knee extensor mechanism reconstruction. Distally based flaps should be carefully considered, as they lead to higher complication rates.
INTRODUCTION: Composite anterolateral thigh (ALT) flap with vascularized fascia lata can reconstitute patellar tendon integrity and knee soft tissue coverage in one stage. However, long-term evidence of outcomes is lacking. This work analyzes long-term functional results, compares subtotal and total reconstruction of patellar tendon, and assesses the respective function of the extensor apparatus. PATIENTS AND METHODS: Outcomes of reconstruction using 10 ALT flaps in 9 patients (age range 21-87 years) were analyzed (mean follow-up 30 ± 6 months). Knee Society Scores, isometric knee extensor strength (M1-M5), and sensory recovery were evaluated, together with active range of motion and extensor lag of the reconstructed limb, compared to contralateral. RESULTS: Ten flaps were used for tendon replacement in 9 patients. Eight (80%) free flaps and 2 (20%) propeller distally based flaps were used. Complications requiring the harvest of a second flap were seen in 2 patients. All patients could return to their daily activities without the use of walking supports. Mean active ROM was 94.4° with an extensor lag of 9.4°, without a significant difference between partial and total patellar tendon reconstruction. The mean knee and functional scores of the Knee Society were 81/100 and 77/100, respectively. CONCLUSION: Composite ALT flap with fascia lata can satisfy the twofold needs of functional restoration and soft tissue coverage, thus ensuring stable results in total and subtotal knee extensor mechanism reconstruction. Distally based flaps should be carefully considered, as they lead to higher complication rates.
Authors: Gianluca Sapino; Loise Lanz; Aurore Roesti; David Guillier; Sebastien Deglise; Giorgio De Santis; Wassim Raffoul; Pietro di Summa Journal: J Clin Med Date: 2022-06-09 Impact factor: 4.964
Authors: Brianna Fram; Eric B Smith; Gregory K Deirmengian; John A Abraham; John Strony; Michael B Cross; Danielle Y Ponzio Journal: Arthroplast Today Date: 2020-01-28