Reconstruction of Disarticulated Knee Stump by Using Distally Based Anterolateral Thigh Island Flap.

Kim, Hyoung Jin; Pyon, Jai Kyong; Burm, Jin Sik; Kim, Yang Woo

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Case Report

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2007;34(4):484-488.
Published online July 1, 2007.

Reconstruction of Disarticulated Knee Stump by Using Distally Based Anterolateral Thigh Island Flap.

Hyoung Jin Kim, Jai Kyong Pyon, Jin Sik Burm, Yang Woo Kim

Department of Plastic and Reconstructive Surgery, Mokdong Hospital, Ewha Womans University, Seoul, Korea. psbboy@gmail.com, pspriest.pyon@samsung. com

Abstract

PURPOSE
The basic vascular anatomy and versatility of the anterolateral thigh flap was reported firstly by Song in 1984 and then by Zhang who introduced the reverse flow pattern of this flap. In this case, the authors reviewed various articles and their experiences with the distally based anterolateral thigh flap and applied it for coverage of bone-exposed wound occurred at the distal of the disarticulated knee stump. We consequently reported the reliability and resourcefulness of this flap in the difficult and limited situation. METHODS: A 67-year-old-man who had suffered from arteriosclerotic obliterans inevitably underwent the disarticulation at knee joint due to clinical deterioration. He presented to our clinic with soft tissue necrosis and bone exposure at the stump. We debrided the wound and conducted the distally based anterolateral thigh island flap by transecting proximal portion of descending branch of the lateral circumflex femoral artery and the 14x10cm sized flap was transferred to cover the defect. The pedicle measured 14cm in length with pivot point 7cm above the patella.
RESULTS
The postoperative course was mainly uneventful except early venous congestion for 4 days and subsequent partial skin loss. The wound was healed by secondary intension and no other sequelae had been observed during follow-up period of 12 months.
CONCLUSION
Despite the presence of various reconstructive choices, the distally based anterolateral thigh island flap can be designed to repair soft tissue defects around the knee region, providing its reliable blood supply and long pedicle length, especially in the challenging cases.

Keywords: Distally based anterolateral thigh island flap; Reconstruction of knee

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