Techniques in soft tissue coverage around the knee

Abstract: Delayed wound healing may have potentially devastating consequences to the final outcomes of surgical procedures around the knee. Issues with necrosis of the skin and subsequent infection may threaten bony healing or prosthesis retention and could lead to the eventual need for debridement or hardware removal. One of the most important aspects in the management of these difficult situations is to obtain stable soft tissue coverage over the defect. The use of musculocutaneous or fasciocutaneous flaps has been very effective in achieving this goal. Recruiting tissue from a remote source not only successfully provides closure of the knee joint or coverage of exposed critical structures around the knee but also aids in the clearing of infections by improving the vascularity in the area. Several techniques, including skin grafts, local skin flaps, rotational muscle flaps, and free flaps, have been used both prophylactically and for salvage procedures for complications that occur after knee surgery. The gastrocnemius muscle flap has proven to be a dependable method of providing knee coverage; however, for those patients in whom the integrity of the muscle or its blood supply has been compromised, other techniques must be considered. In this paper, new advances in soft tissue reconstructive techniques will be discussed. A review of the results and complications will be presented, along with possible future advances.