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    Systematic Review and Comparative Meta-Analysis of Outcomes Following Pedicled Muscle versus Fasciocutaneous Flap Coverage for Complex Periprosthetic Wounds in Patients with Total Knee Arthroplasty.
    Arch Plast Surg 2017 Mar 15;44(2):124-135. Epub 2017 Mar 15.
    Department of Plastic Surgery, Georgetown University Hospital, Washington, DC, USA.
    Background: In cases of total knee arthroplasty (TKA) threatened by potential hardware exposure, flap-based reconstruction is indicated to provide durable coverage. Historically, muscle flaps were favored as they provide vascular tissue to an infected wound bed. However, data comparing the performance of muscle versus fasciocutaneous flaps are limited and reflect a lack of consensus regarding the optimal management of these wounds. The aim of this study was to compare the outcomes of muscle versus fasciocutaneous flaps following the salvage of compromised TKA.

    Methods: A systematic search and meta-analysis were performed to identify patients with TKA who underwent either pedicled muscle or fasciocutaneous flap coverage of periprosthetic knee defects. Studies evaluating implant/limb salvage rates, ambulatory function, complications, and donor-site morbidity were included in the comparative analysis.

    Results: A total of 18 articles, corresponding to 172 flaps (119 muscle flaps and 53 fasciocutaneous flaps) were reviewed. Rates of implant salvage (88.8% vs. 90.1%, P=0.05) and limb salvage (89.8% vs. 100%, P=0.14) were comparable in each cohort. While overall complication rates were similar (47.3% vs. 44%, P=0.78), the rates of persistent infection (16.4% vs. 0%, P=0.14) and recurrent infection (9.1% vs. 4%, P=0.94) tended to be higher in the muscle flap cohort. Notably, functional outcomes and ambulation rates were sparingly reported.

    Conclusions: Rates of limb and prosthetic salvage were comparable following muscle or fasciocutaneous flap coverage of compromised TKA. The functional morbidity associated with muscle flap harvest, however, may support the use of fasciocutaneous flaps for coverage of these defects, particularly in young patients and/or high-performance athletes.

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    What Factors Influence the Success of Medial Gastrocnemius Flaps in the Treatment of Infected TKAs?
    Clin Orthop Relat Res 2016 Mar 16;474(3):752-63. Epub 2015 Nov 16.
    Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL, 60612, USA.
    Background: Soft tissue defects after TKA are a potentially devastating complication. Medial gastrocnemius flaps occasionally are used to provide soft tissue coverage, most commonly with a periprosthetic joint infection.

    Questions/purposes: We asked: (1) What were the rates of persistent or recurrent infection, implant survivorship, flap-related complications, and reoperation for patients who underwent medial gastrocnemius flap reconstruction for soft tissue coverage after TKA? (2) What were the Knee Society clinical and functional scores for patients who underwent medial gastrocnemius flap reconstruction for soft tissue defects after TKA? (3) What were the risk factors for failure of medial gastrocnemius flap reconstruction after TKA, with failure defined as recurrent or new periprosthetic joint infection or inability to reimplant the TKA prosthesis?

    Methods: Between 2003 and 2011, four surgeons at one institution performed 31 medial gastrocnemius flaps for soft tissue coverage over an infected TKA. Read More
    Muscle versus Fasciocutaneous Free Flaps in Lower Extremity Traumatic Reconstruction: A Multicenter Outcomes Analysis.
    Plast Reconstr Surg 2017 Sep 15. Epub 2017 Sep 15.
    1Division of Plastic and Reconstructive Surgery, Duke University Medical Center, Durham, NC, 27710, USA 2Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA 3Division of Plastic Surgery, University of Pennsylvania Health System, Philadelphia, PA, 19104, USA 4Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, PA, 19104, USA.
    Purpose: Clinical indications are expanding for the use of fasciocutaneous free flaps in lower extremity traumatic reconstruction. We assessed the impact of muscle versus fasciocutaneous free flap coverage on reconstructive and functional outcomes.

    Methods: A multicenter retrospective review was conducted on all lower extremity traumatic free flaps performed at Duke University (1997-2013) and the University of Pennsylvania (2002-2013). Read More
    Long-Term Outcomes of Total Knee Arthroplasty following Soft-Tissue Defect Reconstruction with Muscle and Fasciocutaneous Flaps.
    Plast Reconstr Surg 2016 Jan;137(1):177e-186e
    Cleveland, Ohio From the Departments of Plastic Surgery and Orthopaedic Surgery, Cleveland Clinic.
    Background: Insufficient soft-tissue coverage following total knee arthroplasty jeopardizes prosthesis retention and may lead to significant complications. The aim of this study was to evaluate the natural history of total knee arthroplasty following flap reconstruction of soft-tissue defects.

    Methods: A retrospective review of patients treated with flaps after failed total knee arthroplasty between 1998 and 2013 was conducted. Read More
    Comparing Muscle and Fasciocutaneous Free Flaps in Lower Extremity Reconstruction--Does It Matter?
    Ann Plast Surg 2016 May;76 Suppl 3:S213-5
    From the Division of Plastic Surgery, Stanford University, Stanford, CA.
    Introduction: Plastic surgeons are often asked to assist with the reconstruction of lower extremity wounds. These patients many times require free tissue transfer for coverage given paucity of soft tissue. Anecdotally, many orthopedic surgeons prefer muscle coverage--particularly in the setting of potentially infected bone. Read More