PEDICLED MUSCLE FLAPS FOR THE MANAGEMENT OF IMPLANT COMPLICATIONS IN THE LOWER LIMBS:A REPORT

Saleh Alhotan

doi:10.5937/sanamed0-56489

Saleh Alhotan Qassim University, College of Medicine, Department of Surgery, Buraydah, Saudi Arabia

DOI: https://doi.org/10.5937/sanamed0-56489

Keywords: Hardware salvage, Peroneus brevis, medial gastrocnemius, pedicled muscle flap, external fixators, free flap, graft take, total knee arthroplasty

Abstract

Introduction: Metallic implants are widely used for the reconstruction of bony defects caused by fractures, excision of cancer, and degenerative bone disorders. These implants are associated with complications, including exposure and infection, particularly when vascularized tissue is needed for reconstruction. A key tool in plastic surgery to address these complications is the pedicled muscle flap.

Case Report: This article presents two cases in which pedicled medial gastrocnemius and peroneus brevis muscle flaps were successfully used to salvage the hardware and achieve effective wound coverage.

Conclusion: Pedicled medial gastrocnemius and peroneus brevis muscle flaps are valuable options for covering complicated skin defects over exposed implants.

References

Pollak AN, Jones AL, Castillo RC, Bosse MJ, MacKenzie EJ; LEAP Study Group. The relationship between time to surgical debridement and incidence of infection after open high-energy lower extremity trauma. J Bone Joint Surg Am. 2010;92(1):7-15. doi: 10.2106/JBJS.H.00984.

Mardourian M, Wiesemann GS, Sachse CC, Nichols DS, Hagen JE, Chim H. Hardware salvage in the lower extremity after flap coverage: 10-year single center outcomes analysis. Plast Reconstr Surg Glob Open. 2023;11(7):e5105. doi: 10.1097/GOX.0000000000005105.

Fallico N, Somma F, Cigna E, Dessy LA, Tarallo M, Ribuffo D. Coverage of exposed hardware after lower leg fractures with free flaps or pedicled flaps. Eur Rev Med Pharmacol Sci. 2015;19(24):4715-21.

Kilic A, Denney B, de la Torre J. Reconstruction of knee defects using pedicled gastrocnemius muscle flap with split-thickness skin grafting: a single surgeon's experience with 21 patients. J Knee Surg. 2019;32(5):463-7. doi: 10.1055/s-0038-1653965.

El-Sherbiny M. Pedicled gastrocnemius flap: clinical application in limb sparing surgical resection of sarcoma around the knee region and popliteal fossa. J Egypt Natl Canc Inst. 2008;20(2):196-207.

Mayoly A, Mattei JC, Moullot P, Jaloux C, Rochwerger A, Casanova D, et al. Gastrocnemius myocutaneous flaps for knee joint coverage. Ann Plast Surg. 2018;81(2):208-14. doi: 10.1097/SAP.0000000000001451.

Tetreault MW, Della Valle CJ, Bohl DD, Lodha SJ, Biswas D, Wysocki RW. What factors influence the success of medial gastrocnemius flaps in the treatment of infected TKAs? Clin Orthop Relat Res. 2016;474(3):752-63. doi: 10.1007/s11999-015-4624-z.

Bajantri B, Bharathi R, Ramkumar S, Latheef L, Dhane S, Sabapathy SR. Experience with peroneus brevis muscle flaps for reconstruction of distal leg and ankle defects. Indian J Plast Surg. 2013;46(1):48-54. doi: 10.4103/0970-0358.113706.

Mégevand V, Scampa M, Suva D, Kalbermatten DF, Oranges CM. Versatility of the peroneus brevis muscle flap for distal leg, ankle, and foot defects: a comprehensive review. JPRAS Open. 2024; 41:230-9. doi: 10.1016/j.jpra.2024.06.008.