Free flap coverage for knee salvage.

Soft-tissue reconstruction using free flaps was reviewed in 11 consecutive knee wounds complicated by joint exposure or adjacent osteomyelitis and unavailability of adequate local flaps. Ten free muscle flaps and one fasciocutaneous flap were used successfully. Eight limbs presented with wide exposure of the knee joint, including 4 patients with wound infection involving the joint. Three other patients suffered osteomyelitis immediately adjacent to the knee. All knees were successfully salvaged with a single free flap operation, except for one knee that required a second free flap after flap necrosis. Follow-up in nine flaps ranged from 7 weeks to 19 months (mean, 12 months). For patients without preexisting conditions affecting the knee, free flap coverage provided excellent return of knee function. The choice of recipient vessels was determined mainly by the region of the knee requiring coverage. The recipient arteries utilized included the distal superficial femoral artery, anterior tibial artery, popliteal artery, and small arteries, which included the saphenous artery and descending branch of the lateral circumflex femoral artery. The use of small arteries and venae comitantes as recipient vessels increased the effective reach of the free flaps and eliminated the need for vein grafts.