Knee Region Coverage with Reversed Gracilis Pedicle Flap (GReSP Flap).

INTRODUCTION: To treat severe soft-tissue complications of total knee arthroplasty, we used an extended reversed gracilis flap based on secondary pedicles (the GReSP flap). STEP 1 PREPARE WOUND BED: Locate the gracilis and pedicles, then debride the wound bed. STEP 2 EXPOSE GRACILIS MUSCLE: Expose the superficial aspect of the muscle, while protecting the saphenous vein and nerve. STEP 3 CHECK MUSCLE PERFUSION: Temporarily clamp the main vascular pedicle to ensure blood supply when perfused only by the secondary pedicles. STEP 4 MOBILIZE MUSCLE FLAP: Transect the proximal tendon of the gracilis muscle to provide maximal length for the muscle flap and ligate the main vascular and nerve pedicles. STEP 5 COVER WITH SKIN GRAFT: Suture the flap in place and cover with skin graft. STEP 6 POSTOPERATIVE CARE: Immobilize the knee for two weeks; follow with rehabilitation to restore range of motion. RESULTS & PREOP/POSTOP IMAGES: We treated three patients who had an infection at the site of a total knee arthroplasty and exposure of the implant. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.