Table 4.
Summary of studies reporting clinical outcome of gastrocnemius flap reconstruction for soft tissue defects after TKA
| Study | Number of flaps | Gastrocnemius flap timing | Average followup | Complications | Functional outcomes |
|---|---|---|---|---|---|
| McPherson et al. [19] | 21 medial gastrocnemius rotational muscle flaps | At 2nd stage reimplantation TKA (with prior resection and intravenous antibiotics but no interval spacer placement) | 16.8 months | 25 complications in 13 patients; 2 (9.6%) patellar tendon ruptures; 1 (4.8%) repeat periprosthetic joint infection requiring irrigation and débridement and chronic oral antibiotic suppression | At latest followup, mean KSS knee score of 77 (range, 40–100). Based on KSS: 5 excellent, 5 good, 5 fair, and 5 poor results |
| Corten et al. [6] | 22 medial gastrocnemius rotational muscle flaps, 2 lateral gastrocnemius rotational muscle flaps | At 1st stage resection TKA. | 4.5 years | 3 major complications; 1 (4.2%) wound breakdown leading to arthrodesis; 2 (8.3%) repeat periprosthetic joint infections (1 requiring 2-stage revision, 1 needing a latissimus dorsi free flap for wound breakdown with patient considering an above knee amputation) | Mean KSS knee improved from 31 to 68, KSS function from 21 to 35, KSS total score 53 to 103. Based on KSS: 16 good, 5 problematic, 3 failures. SF-12 mental component score from 47.7 to 49.8, SF-12 physical function score from 28.2 to 32.2 |
| Ries [27] | 5 medial gastrocnemius rotational muscle flaps, 1 latissimus dorsi free flap then a medial gastrocnemius rotational muscle flap (3 knees managed without a medial gastrocnemius rotational muscle flap excluded) | 4 at 1st stage resection TKA, 1 at spacer exchange, 1 at 1-stage revision TKA. | 17.3 months | 2 (33%) repeat periprosthetic joint infections treated with second 2-stage revision | Not specified |
| Ries and Bozic [28] | 11 medial gastrocnemius rotational muscle flaps, 1 medial gastrocnemius rotational muscle flap with free flap | 7 at 1st stage resection TKA, 4 at complex primary TKA, 1 at 1-stage revision TKA. | 28 months | 3 (25%) instances of flap necrosis, 2 (17%) requiring additional flap coverage and 1 (8.3%) resulting in above knee amputation; 2 (17%) repeat periprosthetic joint infections (1 treated with oral antibiotic suppression, 1 with 2-stage exchange). Proximal defects over patella and quadriceps tendon often required additional flap coverage. Outcomes worse in infected cases | Not specified |
| Sanders and O’Neill [29] | 5 medial gastrocnemius rotational muscle flaps, 4 lateral gastrocnemius rotational muscle flaps (myocutaneous flaps used with delayed skin closure) | Flaps performed with retention of exposed TKAs. | Not specified | 2 (22%) late infections treated with chronic oral antibiotic suppression; 1 (11%) arthrodesis; 1 (11%) instance of flap necrosis with unhealed wound | Not specified |
| Casanova et al. [3] | 7 pedicled gastrocnemius flaps (medial vs lateral not specified) | Flaps performed with retention of TKAs in place. | 28 months | 1 (14%) repeat periprosthetic joint infection with subsequent arthrodesis | Not specified |
| Gerwin et al. [8] | 12 medial gastrocnemius rotational muscle flaps | 6 flaps performed with retention of exposed TKAs. 6 flaps performed between 1st and 2nd stage of revision TKA. | 32 months | 1 (8.3%) above knee amputation for persistent drainage after index 2-stage revision | Not specified |
| Nahabedian et al. [23] | 19 medial gastrocnemius rotational muscle flaps, 1 fasciocutaneous flap then a medial gastrocnemius rotational muscle flap (9 knees managed without a medial gastrocnemius rotational muscle flap excluded) | 19 flaps after debridement with retention of TKA, 1 flap after failed fasciocutaneous flap | 6.1 years | Of patients treated with a medial gastrocnemius rotational muscle flap, TKA preserved in 16 knees (80%); 4 (20%) had subsequent periprosthetic joint infections; 3 (15%) underwent arthrodesis; 1 (5%) had 2-stage revision. Three (15%) knees required flap advancement with TKA retention | KSS knee score at most recent followup > 90 (“excellent”) in 16 of 20 knees (75%) |
| Markovich et al. [17] | 5 medial gastrocnemius rotational muscle flaps, 1 latissimus dorsi free flap then a medial gastrocnemius rotational muscle flap (6 knees managed without a medial gastrocnemius rotational muscle flap excluded) | 2 flaps performed prophylactically for scarring before primary TKA, 4 flaps as salvage procedures with débridement acutely after TKA for wound dehiscence or acute infection | 28.5 months | 1 patient with persistent drainage for 2 weeks after flap which resolved with 6 weeks of intravenous antibiotics | At most recent followup for prophylactic flaps, mean KSS knee score of 87.5, KSS function score of 80. For salvage flaps, mean KSS knee score of 77.5, KSS function score of 42.5. Based on KSS: 1 excellent, 3 good, 1 fair, and 1 poor result. |
| Menderes et al. [20] | 6 medial gastrocnemius myocutaneous flaps (3 after failed fasciocutaneous flaps), 5 lateral gastrocnemius myocutaneous flaps (6 knees managed without a gastrocnemius flap excluded). | Not specified | 23 months | 2 lateral gastrocnemius flaps (18% of all gastrocnemius flaps) required flap revision and skin grafting; 89% prosthesis salvage rate | Not specified |
| Lian et al. [15] | 2 medial gastrocnemius rotational muscle flaps (5 knees managed without a medial gastrocnemius rotational muscle flap excluded) | Both flaps after débridement with retention of TKA | 58 months | 1 patient who received prior chemotherapy and local radiation therapy had late wound breakdown treated with a revision of the medial gastrocnemius rotational flap; developed pyarthrosis and underwent débridement × 2 and prosthetic revision for a stem fracture | By HSS knee rating scale, 1 good and 1 fair result at most recent followup. |
| Greenberg et al. [10] | 7 medial gastrocnemius rotational muscle flaps, 2 lateral gastrocnemius rotational muscle flaps, 1 knee with both a medial and a lateral gastrocnemius rotational muscle flap | Flaps after débridement with retention of TKA | 2.3 years | 8 (80%) prostheses salvaged; 2 (20%) patients had subsequent arthrodesis | Not specified |
KSS = Knee Society Score; HSS = Hospital for Special Surgery; study by Nahabedian et al. [24] was not independently included in this table given the overlapping patient population with the above study by the same authors [23]. There also presumably was overlap in patient populations between the two studies by Ries [27] and Ries and Bozic [28].