TY - JOUR
T1 - The anterior tibialis artery perforator (atap) flap for traumatic knee and patella defects
T2 - Clinical cases and anatomic study
AU - Rad, Ariel N.
AU - Christy, Michael R.
AU - Rodriguez, Eduardo D.
AU - Brazio, Philip
AU - Rosson, Gedge D.
PY - 2010/2/1
Y1 - 2010/2/1
N2 - Soft-tissue reconstruction of traumatic patella and proximal tibial defects is challenging. Pedicled perforator-based adipocutaneous rotation flaps are a versatile local option as they have axial perfusion and greater freedom of transposition compared with random-pattern flaps, and replace the ideal tissue properties of this anatomic region.Experimental: Anatomic dissections were performed on 15 fresh cadaver legs and location of the dominant perforator measured. Clinical: A retrospective review was conducted at the University of Maryland/R Adams Cowley Shock Trauma Center evaluating patients over a 3-year period.Experimental: Cadaver dissections confirmed a principal perforator at 11.4 ± 1.6 cm inferior to the patella. This vessel is consistently suitable in length and caliber for large rotation flap design. Clinical: Anterior tibial artery perforator flaps were performed on 4 patients following Gustilo IIIB wounds to the patella and tibial plateau. Two patients had rotation flap reconstructions to salvage failed gastrocnemius muscle flaps. All flaps were successful, however, one patient had overwhelming hardware infection several months later despite successfully healed flap.Local anterior tibial artery perforator flaps based on predictable perforators provide reliable coverage of patella and knee defects, bestowing versatility and flexibility to the reconstructive surgeon's armamentarium.
AB - Soft-tissue reconstruction of traumatic patella and proximal tibial defects is challenging. Pedicled perforator-based adipocutaneous rotation flaps are a versatile local option as they have axial perfusion and greater freedom of transposition compared with random-pattern flaps, and replace the ideal tissue properties of this anatomic region.Experimental: Anatomic dissections were performed on 15 fresh cadaver legs and location of the dominant perforator measured. Clinical: A retrospective review was conducted at the University of Maryland/R Adams Cowley Shock Trauma Center evaluating patients over a 3-year period.Experimental: Cadaver dissections confirmed a principal perforator at 11.4 ± 1.6 cm inferior to the patella. This vessel is consistently suitable in length and caliber for large rotation flap design. Clinical: Anterior tibial artery perforator flaps were performed on 4 patients following Gustilo IIIB wounds to the patella and tibial plateau. Two patients had rotation flap reconstructions to salvage failed gastrocnemius muscle flaps. All flaps were successful, however, one patient had overwhelming hardware infection several months later despite successfully healed flap.Local anterior tibial artery perforator flaps based on predictable perforators provide reliable coverage of patella and knee defects, bestowing versatility and flexibility to the reconstructive surgeon's armamentarium.
KW - Island pedicled flaps
KW - Lower extremity reconstruction
KW - Patella reconstruction
KW - Perforator flaps
KW - Propeller flaps
KW - Tibial reconstruction
KW - Tibialis anterior artery
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U2 - 10.1097/SAP.0b013e3181a13dd6
DO - 10.1097/SAP.0b013e3181a13dd6
M3 - Article
C2 - 20098108
AN - SCOPUS:77649118416
SN - 0148-7043
VL - 64
SP - 210
EP - 216
JO - Annals of plastic surgery
JF - Annals of plastic surgery
IS - 2
ER -