Reverse gracilis muscle flap: an alternative means of skin coverage for recurrent infection after TKA.

Abstract

Poor wound-healing and skin necrosis are serious but not unusual complications after total knee arthroplasty, and when skin or soft tissue necrosis occurs, reconstructions in the knee area need thin, pliable, tough skin flaps. A 62-year-old man, who previously underwent multiple TKR operations due to recurrent infection, was transferred from another hospital after a gastrocnemius muscle rotation flap failed. We decided to treat the affected area with a reverse gracilis muscle flap. After confirming that the secondary pedicle was intact by Doppler sonography, muscle dissection was extended to the entry of the secondary pedicle. The proximal tendon of the gracilis muscle was transected, and the muscle was rotated 180° and placed at the recipient site. The aim is to report a case of reconstruction at the anterior knee using a reverse gracilis muscle flap that achieved an excellent final clinical result. This case suggests that the indications for a reverse gracilis muscle flap could be broadened when other flaps are not available for knee prosthesis coverage.