title: Devastating massive knee defect reconstruction using the cornucopian chimera flap from the subscapular axis: two case reports.
abstract: Two cases of successful reconstruction of massive defects around the knee with multiple-island combined flaps based on the subscapular axis are reported. Both defects resulted from aggressive debridement for acute osteomyelitis after open fixation of high-energy fractures around the knee. In Case 1, a four-island combined flap consisting of the scapular flap, the lattissimus dorsi muscle flap, the serratus anterior muscle flap, and the scapular osseous flap, based on the same subscapular axis, was used. Partial bone transport using the Ilizarov apparatus was added as reinforcement of arthrodesis. In Case 2, a five-island combined flap, consisting of the scapular, parascapular flap, the lattissimus dorsi muscle flap, the serratus anterior fascial flap, and the scapular osseous flap, was used. Consequent ankylosis of the knee joint afforded the patient painless full weight bearing without secondary arthrodesis. Multiple-island combined flaps based on the subscapular axis can provide three-dimensional reconstruction of destructive knee defects.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Nippon Medical School Hospital, Tokyo, Japan.
authors.forename: Kazufumi
authors.initials: K
authors.lastname: Sano
authors.forename: Geoffrey G
authors.initials: GG
authors.lastname: Hallock
authors.forename: Satoru
authors.initials: S
authors.lastname: Ozeki
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Suzuki
authors.forename: Reiko
authors.initials: R
authors.lastname: Mawatari
authors.forename: Keishiro
authors.initials: K
authors.lastname: Yoshino
authors.forename: Masahiro
authors.initials: M
authors.lastname: Hamazaki
mesh_terms: D000328:Adult; D001170:Arthritis, Infectious / Q000209:etiology / Q000601:surgery; D016025:Bone Transplantation; D005264:Femoral Fractures / Q000601:surgery*; D018460:Fractures, Comminuted / Q000601:surgery; D006085:Graft Survival; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000637:transplantation*; D010019:Osteomyelitis / Q000209:etiology / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery*; D016038:Skin Transplantation; D013524:Surgical Flaps; D013978:Tibial Fractures / Q000601:surgery*