Published online Nov 18, 2014. doi: 10.5312/wjo.v5.i5.603
Revised: July 2, 2014
Accepted: July 15, 2014
Published online: November 18, 2014
A literature search focusing on flap knee reconstruction revealed much controversy regarding the optimal management of around the knee defects. Muscle flaps are the preferred option, mainly in infected wounds. Perforator flaps have recently been introduced in knee coverage with significant advantages due to low donor morbidity and long pedicles with wide arc of rotation. In the case of free flap the choice of recipient vessels is the key point to the reconstruction. Taking the published experience into account, a reconstructive algorithm is proposed according to the size and location of the wound, the presence of infection and/or 3-dimensional defect.
Core tip: There is much controversy in the literature regarding the optimal management of skin necrosis around the knee. Muscle coverage remains the standard to which all other flaps should be compared. Perforator flaps have recently represented a true revolution in the soft tissue reconstruction around the knee, with peculiar advantages due to their low donor morbidity and long pedicles. In the case of free flap the choice of recipient vessels is the key point to the reconstruction. With meticulous preoperative planning, by identifying the reconstructive needs and by understanding the reconstructive algorithm, the surgeon should be able to manage knee defects with high success rate.