Composite TFL flap for reconstruction of knee extension, a case report

Abstract

Deficiency of the knee extensor mechanism may result from severe injury, loss of structural tissues after tumor resection or complications due to joint replacement surgery. Current treatment options for extensive defects are limited, yielding unsatisfactory functional results and high complication rates. Here, we propose for the first time the use of a free vascularized tissue transfer to reconstruct the extensor mechanism of the knee. The tensor fasciae latae free flap provides sufficient vascularized muscle and fascia as well as a large skin paddle. We present the anatomical concept and long-term outcomes in a patient. • Use of a free, vascularized TFL flap for reconstruction of the knee extensor mechanism is feasible. • A musculotendinous flap can be used to replace the distal quadriceps and patellar tendon, including a skin island if necessary. • Our patient achieved stable ambulation and ability to perform sports such as running or cycling.