Page 159 - Microsurgery

The Knee

This patient presented with skin necrosis following a total knee prosthesis. After resection of
the necrotic tissues, the patella was also found to be necrotic and was excised.

The prosthesis was exposed, as shown in the following images, and extensive lavage was
performed. A medial gastrocnemius flap was raised, and tendon reconstruction was
performed at the level of the patellar tendon. A second lavage was subsequently carried out,
followed by coverage of the distal portion of the muscle flap using a rotational skin flap.

Once the prosthesis was fully covered, skin grafts harvested from the thigh were applied
using a mesh graft technique (tissue expander). The final images demonstrate the healing of
the flap and skin grafts.

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