Reverse-flow anterolateral thigh perforator: an ad hoc flap for severe post-burn knee contracture

Area of Science:

• Plastic Surgery
• Orthopedic Surgery
• Regenerative Medicine

Background:

• Severe post-burn knee contractures significantly impair joint mobility and quality of life.
• Reconstruction of these defects presents challenges due to scar tissue and limited local tissue availability.

Purpose of the Study:

• To evaluate the functional outcomes of using the reverse-flow anterolateral thigh (ALT) perforator flap for severe post-burn knee contracture reconstruction.
• To identify critical surgical factors for successful outcomes.

Main Methods:

• A retrospective study of 10 male patients with severe post-burn knee contracture (35-75 degrees flexion contracture).
• Reconstruction was performed using ipsilateral reverse-flow ALT perforator flaps.
• Standardized rehabilitation protocols were implemented post-operatively.

Main Results:

• 80% of patients showed improved knee range of motion after reconstruction and rehabilitation.
• Minor complications included transient congestion, superficial flap necrosis, and partial skin graft loss.
• Two patients required secondary debulking procedures for hypertrophic scarring.

Conclusions:

• The reverse-flow ALT perforator flap is a valuable option for reconstructing knee soft-tissue defects post-burn, offering good functional and aesthetic results.
• Optimal outcomes depend on meticulous surgical technique, including muscle cuff inclusion, appropriate pivot point selection, prevention of pedicle compression, and early intervention.