• Archives of Plastic Surgery
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• v.49 no.1
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• pp.108-114
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• 2022

Reconstruction of defects around the knee region requires thin and pliable skin. The superior lateral genicular artery (SLGA) flap provides an excellent alternative to muscle-based flaps. The anatomy and the surgical techniques of the SLGA flap were reviewed and the results of cases using the SLGA flap for coverage of knee and proximal leg defects were analyzed. SLGA flaps were performed in two cases and followed up for at least 6 months. Twelve articles on the use of the SLGA flap were also identified. A review of 39 cases showed that the mean diameter of the perforator supplying the skin of the flap was 1.04 mm, while the mean diameter of the SLGA at its origin was 1.78 mm. The mean length of the pedicle measured from the origin of the popliteal artery was 7.44 cm. The average dimensions of the flap were 14.8×6.6 cm with primary closure of the donor site in 61.5% of cases. Of these cases, 38.5% were due to trauma, 23.1% were post-burn complications, 12.8% were defects after resection of tumors, and 10.3% were for ulcers post-bursectomy. The most common complication was flap tip necrosis. All studies reported favorable outcomes with complete wound healing.

• Archives of Plastic Surgery
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• v.34 no.4
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• pp.485-489
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• 2007

Purpose: The basic vascular anatomy and versatility of the anterolateral thigh flap was reported firstly by Song in 1984 and then by Zhang who introduced the reverse flow pattern of this flap. In this case, the authors reviewed various articles and their experiences with the distally based anterolateral thigh flap and applied it for coverage of bone-exposed wound occurred at the distal of the disarticulated knee stump. We consequently reported the reliability and resourcefulness of this flap in the difficult and limited situation. Methods: A 67-year-old-man who had suffered from arteriosclerotic obliterans inevitably underwent the disarticulation at knee joint due to clinical deterioration. He presented to our clinic with soft tissue necrosis and bone exposure at the stump. We debrided the wound and conducted the distally based anterolateral thigh island flap by transecting proximal portion of descending branch of the lateral circumflex femoral artery and the $14{\times}10cm$ sized flap was transferred to cover the defect. The pedicle measured 14 cm in length with pivot point 7 cm above the patella. Results: The postoperative course was mainly uneventful except early venous congestion for 4 days and subsequent partial skin loss. The wound was healed by secondary intension and no other sequelae had been observed during follow-up period of 12 months. Conclusion: Despite the presence of various reconstructive choices, the distally based anterolateral thigh island flap can be designed to repair soft tissue defects around the knee region, providing its reliable blood supply and long pedicle length, especially in the challenging cases.

• Journal of the Korean Arthroscopy Society
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• v.3 no.1
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• pp.40-43
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• 1999

Arthroscopic anterior cruciate ligament(ACL) reconstruction using four-strand hamstring tendon with looping around transfixing screw in femoral tunnel requires osteointegration between the grafted tendon and bone for stability of the knee. Authors have experienced a histologic finding of osteointegration between the grafted autogenous hamstring tendon and bone in femoral tunnel after arthroscopic ACL reconstruction. A patient received arthroscopic ACL reconstruction with autogenous four strand hamstring tendon for the ACL injury. Traumatic re-rupture of mid-substance of ACL graft was developed at thirteenth week after operation. During the procedures of arthroscopic revision at fifteenth week after initial ACL reconstruction, biopsy was performed at the site of interface between grafted tendon and bone in femoral tunnel. Integration between the grafted tendon and bone was evident by demonstrating the continuity of collagen fiber between bond and tendon. This histologic finding and the low incidence of early graft failure suggest that free tendon autograft attached to bone by looping around a transfixing screw in femoral tunnel undergoes adequate osteointegration between 12 and 15 weeks after surgery and authors thought that insertion of bone chip into the femoral tunnel would accelerate osteointegration procedure.

• The Journal of the Korean bone and joint tumor society
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• v.9 no.1
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• pp.124-129
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• 2003

Purpose: To analyze the clinical outcome and radiological features after surgical treatment of stage III giant cell tumor around the knee. Materials and Methods: 21 patients with stage III giant cell tumor around the knee joint, who were operated at our institutes between March 1991 and February 2000, were selected for this study. The average follow-up was 5.7 years (range, 1~9 years). After thorough curettage using high speed burr, cryosurgery and cementing with polymethymethacrylate (PMMA) were performed in 11 patients. 7 patients were treated with PMMA cementing (4 patients) or bone grafting (3 patients) after curettage without cryosurgery. Reconstruction with prosthesis composite allograft and knee fusion with Huckstep nail were performed in 3 patients with huge defect and joint perforation. Results: Local recurrence developed in 1 out of 11 patients who was treated with curettage and cementing with cryosurgery (9.1%) and 3 out of 7 patients who underwent curettage and cementing without cryosurgery (28.6%). Joint space narrowing more than 3mm was noted in 1 patient (9.1%), who treated with cryosurgery and anther patient (14.5%) who treated without cryosurgery. There was no local recurrence in case of wide resection and reconstruction. Conclusion: Thorough curettage and PMMA cementing with cryosurgery as an adjuvant is thought to be effective modalities in the treatment of stage 3 giant cell tumors around the knee. Wide resection and reconstruction can be reserved mainly for the cases of stage 3 giant cell tumor with significant cortical destruction and marked joint destruction, and the cases of local recurrence with poor bone stock.

• Archives of Reconstructive Microsurgery
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• v.11 no.1
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• pp.11-18
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• 2002

Large soft tissue defects around the knee joint are known to significantly diminish joint function. Severe soft tissue defects on the anterior aspect of the knee joint especially bring on significant joint motion limitation. Although simple split skin grafts can cover the skin defect, the progressing scar contracture of the grafted skin causes joint stiffness. One of the best solutions of large soft tissue defects around the knee joint is covering the defect with a good quality skin flap. Separated flaps with one vascular pedicle are good candidates for covering anterior and posterior aspects of the joint for example. Authors performed 12 cases of combined scapular and latissimus dorsi free flaps from 1984 to 2000. Among them, we experienced 5 cases of knee joint defect covering using the double free flap for coverage of the soft tissue defect with preservation of the knee joint function and satisfactory results. The system of flaps based on the subscapular artery and vein provides a variety of composite free flaps. The possible flaps that can be harvested based on this single vascular pedicle include the scapular and parascapular skin flap, the serratus anterior and latissimus dorsi muscular flap, the lateral scapular bone flap, the latissimus dorsi-rib flap, and the serratus anterior-rib flap. This combined flap is available for multiple tissue defects or complex defects because it can be incorporated with skin, muscle and bone flaps. A main advantage is the independent vascular pedicles of each component, which allow freedom in orientation of each components. Consequently it can be freely applied to any form of three dimensional defects on the upper and lower extremities. The combination of scapular cutaneous flap and latissimus dorsi musculocutaneous flap can be resurfaced for massive cutaneous defects on the extremities. We report the use of the combined scapular and latissimus dorsi free flap in five patients to reconstruct massive defects on the extremities with resultant improved joint function. There was no flap failure and minimal complications and disadvantages. The anatomy of this flap is reviewed and the indication and advantages are discussed. All of the five flaps survived and there was no scar contracture affecting the joint motion.

• Journal of Korean Orthopaedic Sports Medicine
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• v.3 no.2
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• pp.128-133
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• 2004

Purpose: This study was planned to evaluate complications? of posterior cruciate ligament (PCL) reconstruction with tibial inlay technique using autogenous bone-patellar tendon-bone graft. Materials and Methods: From September 1994 to January 2004, we analyzed surgical complications in fifty-seven patients with fifty-eight cases who underwent PCL reconstruction. Fifty of them were male and seven female. The mean age of the patients was 35(15$\~$73). Twenty eight cases of injury were isolated PCL, while thirty cases had associated injury of knee. The causes of injury were thirty-nine cases of traffic accident, seven sport injuries, seven fall down injuries, and five of others. The follow-up study was done at 4 weeks, 3 months,6 months and 1 year after surgery. KT-2000 arthrometer and posterior stress X-ray were used to examine the stability of the knee joint and the Lysholm Knee Score and a variety of clinical complications were evaluated. Results: Although the mean score of the preoperative Lysholm Knee Score was 43.2, the postoperative score was increased to 87.9. The preoperative mean value of knee stability using KT-2000 arthrometer was 8.75 mm(6.2$\~$14.3 mm) but the postoperative mean was 3.41 mm(2.1$\~$10.6 mm). The intraoperative complications were: one case of popliteal artery injury with compartment syndrome, one case of patellar fracture, two cases of 20$^{\circ}$ flexion loss, and two cases of anterior cortical penetration of the screw through proximal tibia during screw fixation. The postoperative complications were: eleven cases of knee instability, one case of patellar fracture, five cases of extension loss, thirteen cases of flexion loss, twenty-one cases of around knee pain and eight cases of kneeling pain. Conclusion: After PCL reconstruction with tibial inlay technique using autogenous bone-patella tendon-bone graft, complications were observed in this study. Careful attention during and after the operation, as well as rehabilitation must be required.

• Journal of Korean Orthopaedic Sports Medicine
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• v.7 no.2
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• pp.122-127
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• 2008

Purpose: Evaluation and analysis of the incidence of postoperative complications after arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft. Materials and Methods: We reviewed 172 cases of arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft in anterior cruciate ligament tear without meniscal injury. We performed Lysholm knee score and KT-2000 testing, simple radiograph, physical examination as evaluation factor. Also, around knee pain, swelling, limitation of motion, patellofemoral crepitation, paresthesia and pain on kneeling were evaluated. Results: The average follow up period was 49.8 months. In 172 patients, 148 males and 26 femlaes were evaluated. The average age was 34.4 years. The Lysholm knee score improved from 51.9 points preoperatively to 90.8 points at final follow up. Clinical outcome was excellent in 83%, good in 11%, fair in 4% and poor in 2%. There were many cases of complications, 24 cases (14%) of around knee pain, 12 cases (7%) of swelling, 45 cases (26.2%) of patellofemoral crepitation, 52 cases (30%) of donor site paresthesia, 65 cases (38%) of pain on kneeling, 10 cases (5.8%) of limitation of motion at extension, 13 cases (8%) of limitation of motion at flexion and 2cases (1.2%) of patellar fracture. Conclusion: Although arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone had good clinical results, many complications were noted. Some factors in surgical technique were suspected to be related to the complications and long term follow up will be necessary to further evaluated.

• The Journal of the Korean bone and joint tumor society
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• v.10 no.2
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• pp.120-123
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• 2004

Benign and malignant bone tumors occur most commonly around the knee. The proximal tibia is the most technically demanding site for limb salvage surgery. The most difficult problem using an endoprothesis for proximal tibial resection has been reconstruction of the extensor mechanism. After excision of proximal tibia, we resected distal femur and made a composite with resected distal femur, low heat treated autogenous proximal tibia and endoprothesis. Patella was fixed into the resected down-loaded distal femur. This article shows the new technique and the results of reconstruction of extensor mechanism after prosthetic replacement of the proximal tibia.

• Journal of the Korean Arthroscopy Society
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• v.9 no.2
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• pp.167-173
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• 2005

Purpose: The purpose of this study is to evaluate the clinical results of posterior cruciate ligament (PCL) and posterolateral structure (PLS) reconstruction using bilateral hamstring tendon autografts. Materials and Methods: From October 2002 to March 2004, ten patients were received PCL and PLS reconstruction simultaneously using bilateral hamstring autografts. PCL was reconstructed using ipsilateral hamstring tendon and fixed with cross pins and Intrafix (Mitek, Norwood, MA). PLS was reconstructed using contralateral hamstring tendon. The mean follow up was 17 months. Clinical assessments consisted of Lysholm knee scores, International Knee Documentation Committee (IKDC) evaluation form and posterior stress radiographs. External rotation of tibia was evaluated at $30^{\circ}\;and\;90^{\circ}$ knee flexion using Noyes and Barber-Westin's classification. Contralateral harvest site morbity was evaluated using IKDC evaluation form and flexion power of the knee. Results: Mean posterior displacement of tibia using stress radiographs was improved from 13.3 mm to 3.7 mm. In tibial external rotation evaluation, 7 patients were functional, 2 patients were partially functional and one failure. The average Lysholm knee score improved from 54 preoperatively to 86 postoperatively. At the final IKDC evaluation, 8 patients were graded as nearly normal, 2 were graded as abnormal. In contralateral harvest site morbidity evaluation, 2 patients complained of numbness around the wound but negligible. Conclusion: PCL and PLS reconstruction using bilateral hamstring autografts was considered as a good treatment method with minimal contralateral harvest site morbidity.

• The Journal of the Korean bone and joint tumor society
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• v.5 no.1
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• pp.9-16
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• 1999

A new method of limb sparing by resection, extracorporeal irradiation and reimplantation has several theoretical advantages. This method preserves the mobility of a joint and avoids the problem of loosening or breakage of tumor prosthesis. This study involved using extracorporeal irradiated autogenous joint transplantation for reconstruction after en bloc resection, and observed the periods of functional union and histological changes in irradiated tissue of the knee joint. This study also aimed to clarify whether the degeneration of articular cartilage is induced in rabbits by a single 50Gy dose of irradiation at the knee joint. Twenty New Zealand rabbits about three kilograms were randomized into two groups of 10 rabbits each. In group 1, as control, we resected the knee joint followed by reimplantation without irradiation. Group 2 received extracorporeal irradiation on the resected knee joint followed by reimplantation. Following are the results of these observations. The osteotomy site showed external callus formation in the roentgenographic finding eight weeks after reimplantation. There was marked degenerative changes in the collagen fiber of the irradiated anterior cruciate ligament and meniscus during the fourth week, but new blood-vessel formation was observed in the vicinity. There was degenerative changes in the collagen fiber of articular cartilage treated extracorporeal irradiation at four and eight weeks in the scanning electron micrographic findings. These findings was in contrast to those of subchondral bone which showed decreased cellularity and empty lacuna at four and eight weeks. Autoradiography demonstrated active [$^3H$]uridine incorporation by irradiated chondrocyte at eight weeks after reimplantation. These results indicate that when destruction of the articular cartilage and soft tissue of the knee joint is not severe, extracorporeal irradiation and reimplantation can be used with several advantage in maintaining movement of the joint while avoiding problems of tumor prosthesis and rejection, and therefore extracorporeal irradiated autogenous joint transplantation can be used as a limb-sparing procedure for temporary biological spacer in the childhood bone tumor around the knee.