Medial Gastrocnemius Flap in the Reconstruction of Infected Total Knee Arthroplasty

Abstract

Purpose: To evaluate the results of the medial gastrocnemius muscle flap to cover the wound necrosis and dehiscence caused by repeated surgery in the reconstruction of infected total knee arthroplasty (TKA). Materials and Methods: Out of forty three reconstructions of infected TKA performed between 1995 and 2002, eleven cases (25.6%) underwent medial gastrocnemius flap to cover the anterior skin defects at the time of reimplantation in two cases and in an average 3.3 weeks after reimplantation in seven cases. Two cases which refused reimplantation were treated by arthrodesis and delayed flap coverage and by flap surgery only resulting in pseudarthrosis respectively. They were five male and six female patients of 61 years (range, 56-77 years) of age in average. Clinical and radiological assessments were done for minimum two years of follow-up. Results: Nine cases (81.8%) maintained TK prostheses with less range of motion (in average) than ordinary TKAs of primary healing. Two patients refused TKA which resulted in one arthrodesis and one pseudarthrosis. There was no case of recurrence of wound dehiscence or infection. Conclusion: Medial gastrocnemius flap can salvage the prostheses by providing good soft tissue coverage for compromised operative wounds caused by infected TKA and repeated surgical interventions.