Bone, tendon, and soft tissue reconstruction in one stage with the composite tensor fascia lata flap

A 46-year-old patient sustained a dia-infracondylar tibial fracture after a ski accident. Open reduction and internal fixation (ORIF) was carried out. After an initially uneventful postoperative course the patient was readmitted because of local and systemic infection signs. Radical surgical debridement was carried out following by Vacuum-Assisted Closure (VAC) therapy. The resulting defect consisted of bone defect of the tibia tuberosity, and complete loss of the patellar tendon and the overlying soft tissue. Reconstruction was carried out with a combined tensor fascia lata (TFL) flap including the TFL muscle with the ilio-tibial tract, vascularized part of the iliac crest and the overlying soft tissue. Bone healing took place without signs of osteomyelitis recurrence, and full weight bearing was possible 4 months after reconstruction. Successful reconstruction of the patellar tendon using the ilio-tibial tract, enables the patient full active knee joint motion. The soft tissue coverage shows stable conditions. The donor site showed inconspicuous healing without pain and normal range of motion of the hip joint. So this composite TFL flap is an interesting flap not only for defects following trauma, but also for combined defects following extensive infections after knee implants.