title: Reconstruction of knee joint soft tissue and patellar tendon defects using a composite anterolateral thigh flap with vascularized fascia lata.
abstract: Reconstruction of a complex knee trauma with knee joint exposure and composite soft tissue and patellar tendon deficiency remains a challenging task. Multiple-stage reconstruction is time-consuming and produces considerable suffering for patients. Early mobilization following knee reconstruction has achieved good outcomes. Herein, we reported one-stage reconstruction with an ALT myocutaneous flap with vascularized fascia lata was utilized for one patient with a large complex knee joint soft tissue defect, and segmental deficiency of the patellar tendon. The fascia lata sheet was rolled to mimic a patellar tendon. The exposed knee joint was obturated by the vastus lateralis muscle of the ALT myocutaneous flap. The skin and soft tissue defect was reconstructed using the skin paddle of the ALT flap. The patient's postoperative course was uneventful. An MRI examination demonstrated good continuity of the reconstructed patellar tendon. The active ROM of the injured knee reached 100 degrees (extension deficiency 20 degrees and flexion 120 degrees ) at 5 years. Objective functional assessment of the patella-femoral joint utilized a kinetic communicator machine (Kin-Com 500H, Chattecx, Chattanooga, TN, USA) revealed still mild extension insufficiency. However, the patient reported that he was able to perform normal daily activities without difficulty at 5-year follow-up.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University, College of Medicine, Kaohsiung 83305, Taiwan. t1207816@ms22.hinet.net
authors.forename: Yur-Ren
authors.initials: YR
authors.lastname: Kuo
authors.forename: Po-Chung
authors.initials: PC
authors.lastname: An
authors.forename: Mei-Hui
authors.initials: MH
authors.lastname: Kuo
authors.forename: Nai-Siong
authors.initials: NS
authors.lastname: Kueh
authors.forename: Sheng-Fa
authors.initials: SF
authors.lastname: Yao
authors.forename: Seng-Feng
authors.initials: SF
authors.lastname: Jeng
mesh_terms: D000062:Accidents, Occupational; D000368:Aged; D005206:Fascia Lata / Q000098:blood supply / Q000637:transplantation*; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D007719:Knee Joint / Q000502:physiology; D008279:Magnetic Resonance Imaging; D008297:Male; D017847:Patellar Ligament / Q000293:injuries* / Q000601:surgery; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D013524:Surgical Flaps