Knee Reconstruction Workup

  • Author: Steven L Bernard, MD; Chief Editor: Jorge I de la Torre, MD, FACS   more...
 
Updated: Feb 24, 2012
 

Laboratory Studies

  • Routine preoperative screening of healthy people undergoing elective surgery is not recommended.
  • A serum creatinine level should be ordered for patients older than 40 years.
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Imaging Studies

  • Order a chest radiograph in patients older than 60 years.
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Other Tests

  • Order an ECG in patients older than 40 years.
  • If the patient has a significant history of cardiopulmonary disease, further testing may be indicated (eg, echocardiography, pulmonary function tests).
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Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Steven L Bernard, MD  Department of Plastic Surgery, Cleveland Clinic Foundation, Assistant Professor of Surgery, Case Western Reserve University School of Medicine

Steven L Bernard, MD is a member of the following medical societies: American Association of Plastic Surgeons, American Society of Plastic Surgeons, and Ohio Valley Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Christian Paletta  MD, Complex Wound and Limb Salvage Program, Walter Reed Army Hospital and Bethesda Naval Hospital

Christian Paletta is a member of the following medical societies: Alpha Omega Alpha, American Association of Plastic Surgeons, American Burn Association, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, and Missouri State Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

B Sekhar Chandrasekhar, MD  Associate Professor, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Southern California

B Sekhar Chandrasekhar, MD is a member of the following medical societies: American Association of Plastic Surgeons, American College of Surgeons, American Society for Reconstructive Microsurgery, and California Medical Association

Disclosure: Nothing to disclose.

Nicolas (Nick) G Slenkovich, MD  Director, Colorado Plastic Surgery Center

Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Jorge I de la Torre, MD, FACS  Professor of Surgery and Physical Medicine and Rehabilitation, Chief, Division of Plastic Surgery, Residency Program Director, University of Alabama at Birmingham School of Medicine; Director, Center for Advanced Surgical Aesthetics

Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Robert Rodrigues, MD, to the development and writing of this article.

References

  1. Manoso MW, Boland PJ, Healey JH, Cordeiro PG. Limb salvage of infected knee reconstructions for cancer with staged revision and free tissue transfer. Ann Plast Surg. 2006;56(5):532-5. [Medline].

  2. Chowdri NA, Darzi MA. Z-lengthening and gastrocnemius muscle flap in the management of severe postburn flexion contractures of the knee. J Trauma. Jul 1998;45(1):127-32. [Medline].

  3. Pontén B. The fasciocutaneous flap: its use in soft tissue defects of the lower leg. Br J Plast Surg. Apr 1981;34(2):215-20. [Medline].

  4. Veber M, Vaz G, Braye F, Carret JP, Saint-Cyr M, Rohrich RJ, et al. Anatomical study of the medial gastrocnemius muscle flap: a quantitative assessment of the arc of rotation. Plast Reconstr Surg. Jul 2011;128(1):181-7. [Medline].

  5. Satoh K, Fukuya F, Matsui A, Onizuka T. Lower leg reconstruction using a sural fasciocutaneous flap. Ann Plast Surg. Aug 1989;23(2):97-103. [Medline].

  6. Gill NA, Hameed A. The Sural Compendium: Reconstruction of Complex Soft-Tissue Defects of Leg and Foot by Utilizing the Posterior Calf Tissue. Ann Plast Surg. Jul 5 2011;[Medline].

  7. Wiedner M, Koch H, Scharnagl E. The superior lateral genicular artery flap for soft-tissue reconstruction around the knee: clinical experience and review of the literature. Ann Plast Surg. Apr 2011;66(4):388-92. [Medline].

  8. Chapin SD, Bernard SL, Edington H. The medial thigh adipofascial flap for coverage of anterior knee defects. Presentation at the Ivy Society. 1993.

  9. Eckardt JJ, Lesavoy MA, Dubrow TJ, Wackym PA. Exposed endoprosthesis. Management protocol using muscle and myocutaneous flap coverage. Clin Orthop Relat Res. Feb 1990;(251):220-9. [Medline].

  10. Frame JD, Taweepoke P, Moieman N, Rylah L. Immediate fascial flap reconstruction of joints and use of Biobrane in the burned limb. Burns. Oct 1990;16(5):381-4. [Medline].

  11. Gerwin M, Rothaus KO, Windsor RE, Brause BD, Insall JN. Gastrocnemius muscle flap coverage of exposed or infected knee prostheses. Clin Orthop Relat Res. Jan 1993;(286):64-70. [Medline].

  12. Strauch B, Vasconez LO, Hall-Findlay EJ, eds. Grabb's Encyclopedia of Flaps: Head and Neck. 2nd ed. Philadelphia, Pa: Lippincott-Raven; 1998.

  13. Greenberg B, LaRossa D, Lotke PA, Murphy JB, Noone RB. Salvage of jeopardized total-knee prosthesis: the role of the gastrocnemius muscle flap. Plast Reconstr Surg. Jan 1989;83(1):85-9, 97-9. [Medline].

  14. Hallock GG. Fasciocutaneous Flaps. Boston, Mass: Blackwell Scientific; 1992.

  15. Hayashi A, Maruyama Y. The lateral genicular artery flap. Ann Plast Surg. Apr 1990;24(4):310-7. [Medline].

  16. Jaureguito JW, Dubois CM, Smith SR, Gottlieb LJ, Finn HA. Medial gastrocnemius transposition flap for the treatment of disruption of the extensor mechanism after total knee arthroplasty. J Bone Joint Surg Am. Jun 1997;79(6):866-73. [Medline].

  17. Lewis VL Jr, Mossie RD, Stulberg DS, Bailey MH, Griffith BH. The fasciocutaneous flap: a conservative approach to the exposed knee joint. Plast Reconstr Surg. Feb 1990;85(2):252-7. [Medline].

  18. Li Z, Liu K, Lin Y, Li L. Lateral sural cutaneous artery island flap in the treatment of soft tissue defects at the knee. Br J Plast Surg. Sep 1990;43(5):546-50. [Medline].

  19. Manushakian HS, McDiarmid JG. Reconstruction of a large anterolateral knee defect using a delayed distally based total sartorius flap and a medial gastrocnemius flap. Plast Reconstr Surg. Apr 1998;101(4):1065-9. [Medline].

  20. Maruyama Y, Iwahira Y. Popliteo-posterior thigh fasciocutaneous island flap for closure around the knee. Br J Plast Surg. Mar 1989;42(2):140-3; discussion 144-5. [Medline].

  21. Meller I, Ariche A, Sagi A. The role of the gastrocnemius muscle flap in limb-sparing surgery for bone sarcomas of the distal femur: a proposed classification of muscle transfers. Plast Reconstr Surg. Mar 1997;99(3):751-6. [Medline].

  22. Pant R, Younge D. Turn-up bone flap for lengthening the below-knee amputation stump. J Bone Joint Surg Br. Mar 2003;85(2):171-3. [Medline].

  23. Pico R, Lüscher NJ, Rometsch M, de Roche R. Why the denervated gastrocnemius muscle flap should be encouraged. Ann Plast Surg. Apr 1991;26(4):312-24. [Medline].

  24. Quaba AA, Chapman R, Hackett ME. Extended application of the biceps femoris musculocutaneous flap. Plast Reconstr Surg. Jan 1988;81(1):94-105. [Medline].

  25. Mathes SJ, Nahai F, eds. Reconstructive Surgery: Principles, Anatomy, and Technique. 1st ed. New York, NY: Churchill Livingstone; 1997.

  26. Rhomberg M, Schwabegger AH, Ninkovic M, Bauer T, Ninkovic M. Gastrocnemius myotendinous flap for patellar or quadriceps tendon repair, or both. Clin Orthop Relat Res. Aug 2000;(377):152-60. [Medline].

  27. Serafin D. Atlas of Microsurgical Composite Tissue Transplantation. Philadelphia, Pa: WB Saunders; 1996.

  28. Shaw AD, Ghosh SJ, Quaba AA. The island posterior calf fasciocutaneous flap: an alternative to the gastrocnemius muscle for cover of knee and tibial defects. Plast Reconstr Surg. May 1998;101(6):1529-36. [Medline].

  29. Swartz WM, Ramasastry SS, McGill JR, Noonan JD. Distally based vastus lateralis muscle flap for coverage of wounds about the knee. Plast Reconstr Surg. Aug 1987;80(2):255-65. [Medline].

  30. Thatte RL, Thatte MR. The saphenous venous flap. Br J Plast Surg. Jul 1989;42(4):399-404. [Medline].

  31. Tsai CC, Lin SD, Lai CS, Chou CK, Lin TM. Reconstruction of the upper leg and knee with a reversed flow saphenous island flap based on the medial inferior genicular artery. Ann Plast Surg. Nov 1995;35(5):480-4. [Medline].

  32. Wang Y, Begue T, Masquelet AC. Anatomic study of the distally based vastus lateralis muscle flap. Plast Reconstr Surg. Jan 1999;103(1):101-3. [Medline].

  33. Yuen JC, Zhou AT. Free flap coverage for knee salvage. Ann Plast Surg. Aug 1996;37(2):158-66. [Medline].

 
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This photograph shows a complex degloving wound of the left knee.
With the skin retracted, open fracture and fixation hardware is evident in the wound.
The medial (top) and lateral (bottom) gastrocnemius muscles are elevated and ready for inset and wound coverage. Access to the muscles was through a midline posterior incision (the incision is not seen in this photograph, which is of the anterior leg).
The medial and lateral muscles are sutured to each other and inset over the wound.
The knee wound is healed.
This is an illustration of the adipofascial flap. The drawing shows the flap elevated and ready to be flipped on itself for inset over the wound of the knee.
This photograph shows a leg that cannot be salvaged, even with a standard below-the-knee amputation, because of the extent of damage to both the knee and calf. The foot, however, is in good shape and can be used for a filet of foot flap.
The foot has been isolated on the posterior tibial vessels and tibial nerve. The phalanges and metatarsal bone have all been removed. Of the tarsal bones, only the calcaneus is saved. The intervening tibia and fibula have been removed, as well.
The foot is now rotated 180 degrees and rigidly fixed to the remaining stump of the tibia.
As can be seen in this photograph, the end of the amputation stump now has the excellent and tough coverage of the sole of the foot and heel.
Mobility is preserved in the knee.
The good coverage allows for prosthesis fitting.
The salvage of the knee in this patient allows for greatly improved function over an above-the-knee amputation.
Large wound with extensive damage to the femur and tibia and exposed hardware.
Radiograph of the leg.
Latissimus dorsi muscle free flap is inset into the wound and covered with a split-thickness skin graft.
Healed wound of the knee.
 
 
 
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