The conjoined parascapular and latissimus dorsi free flap for reconstruction of extensive knee defects

BACKGROUND: Extensive soft-tissue defects affecting the knee region pose a significant reconstructive challenge and may require separate or multiple flaps for coverage. We evaluated the conjoined parascapular and latissimus dorsi free flap as an alternative reconstructive option.

METHODS: From January 2013 to December 15, 2016 patients (7 female and 8 male) with a mean age of 47.5 years underwent reconstruction of such defects. Causes were trauma (12 cases) and infection (3 cases). The mean defect size was 40.9 × 20.8 cm (range, 21.4×7.3 to 60.1×40.5 cm). The mean defect surface area was 820.0 cm2 (range, 273.2-2,400.4 cm2 ). The conjoined free flap was anastomosed to the femoral vessels in the adductor canal with (3 cases) or without an arterio-venous loop (8 cases), posterior tibial vessels (3 cases), or anterior tibial vessels (1 case).

RESULTS: Postoperatively, 10 patients experienced a total of 14 complications, of which 9 (7 patients) were considered major (requiring additional surgery) and 5 (4 patients) minor (conservative treatment). There was no total flap loss. Partial flap loss occurred in 5 patients. Major donor-site complications occurred in 6 patients with impaired wound healing (4 cases), seroma (1 case), and hematoma (1 case). Reconstruction was successful in 14 out of 15 patients during a mean follow-up time of 28.6 months (range, 6.0-52.5 months). Twelve patients were able to walk at the last follow-up visit.

CONCLUSIONS: The conjoined parascapular and latissimus dorsi free flap is a large and reliable flap. It allows for simultaneous 1-stage reconstruction of complex and unusually large soft-tissue defects of the knee region.