Prophylactic soft tissue reconstruction of the knee region with a free alt flap prior to total knee arthroplasty
Introduction (case reports only) Good quality soft tissue envelope over total knee arthroplasty (TKA) is mandatory for successful post-operative outcome in knee arthroplasty surgery. Major injuries affecting peri-genicular soft tissue and knee joint might lead to excess scarring and post-traumatic knee joint arthrosis. In this case scenario, complex knee joint reconstruction might be indicated. Case description (case reports only) 51-year-old male patient was referred to Plastic and Reconstructive Surgery Department with a massive scar of the left knee region and post-traumatic end-stage gonarthrosis as a result of a gunshot injury 15 years ago. The patient was consulted by orthopedic surgeon who has recommended a total knee replacement. Due to the massive scar and lack of soft tissue envelope the patient was referred to our department for “prophylactic” soft tissue reconstruction before knee joint replacement. Roughly 12×7 cm post-traumatic scar was observed on the anteromedial aspect of the left knee. The skin was fixed to the tibia and femur with a lack of subcutaneous tissue. Scar and the affected area were excised and that resulted in 15x10cm soft tissue defect that was reconstructed with a single perforator free ALT flap. The flap was anastomosed to superior medial genicular vessels in end-to-end fashion. Post-operative period was uneventful, and the patient underwent successful TKA 6 months later. Summary (case reports only) This clinical case presents successful functional and surgical outcome in complex knee joint reconstruction that required prophylactic soft tissue free flap reconstruction and total knee joint replacement due to gunshot injury to the knee area. Conclusions Collaborative approach between reconstructive plastic surgeons and orthopedic surgeons is mandatory in the decision-making process and surgical execution in complex knee joint reconstructions to ensure successful surgical outcome.