Free myocutaneous latissimus dorsi flap transfer in total knee arthroplasty

Abstract

The purpose of this article is to present our experience with free myocutaneous latissimus dorsi flap transfer in total knee arthroplasty in case of insufficient soft tissue prior to operation ('prophylactic indication'). Fourteen patients who underwent simultaneous flap surgery in the context of total knee arthroplasty because of insufficient soft tissue are reviewed in a retrospective clinical study. The following criteria were examined: (1) aetiology of the soft-tissue defect, (2) number of previous operations, (3) status of the knee extensor mechanism classified as complete, partial or missing, (4) primary wound healing, (5) complications and (6) active range of motion (ROM). Insufficient soft tissue resulted from multiple previous operations in 10 patients and large post-traumatic defects in four patients. All patients had 5-23 (mean 10.2) previous operations before free latissimus dorsi transfer. The status of the extensor mechanism was complete in one, partial in nine and missing in four patients. Primary wound healing could be achieved in eight patients. After free latissimus dorsi transfer, skin breakdown at the recipient site occurred in five patients. Secondary skin grafting was carried out in four patients and a fasciocutaneous flap in one patient. There were three late recurrences of infection, with ultimate removal of the knee prosthesis and conversion to arthrodesis. Average active ROM prior to surgery was for extension/flexion 0-9-28 degrees . One year after surgery the average active ROM was 0-6-75 degrees . A free myocutaneous latissimus dorsi flap transfer is rarely indicated in total knee arthroplasty and should only be considered for defects which cannot be covered by a pedicled (medial gastrocnemius) flap. Free latissimus dorsi transfer makes prosthesis implantation possible, prevents postoperative knee stiffness because of soft tissue and/or scar constriction and shows a low rate of severe complications in patients with a high risk of wound-healing problems. Moreover, transfer of well-vascularised tissue will improve trophicity in the knee region, and thus make future operations in this region easier.