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Knee Extensor Mechanism Reconstruction Using a Free Tensor Fascia Lata Flap With Microsurgical

Laura Hilbig-Vlatten1, Lilly F Stadelmeier1, Eric Shiah2

  • 1Division of Orthoplastic and Reconstructive Microsurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

JBJS Case Connector
|November 13, 2025
PubMed
Summary

This case study demonstrates a successful free vascularized tensor fascia lata flap reconstruction for knee extensor mechanism deficiency. The technique offers a viable solution for complex, revisional cases, restoring function and mobility.

Keywords:
extensor mechanism reconstructionfree flapkneeperforator-to-perforator-anastomosisrevision knee surgerytensor fascia lata flap

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Area of Science:

  • Orthopedic Surgery
  • Microsurgery
  • Reconstructive Surgery

Background:

  • Knee extensor mechanism deficiency presents a significant challenge in reconstructive surgery.
  • Revisional surgeries for this condition are often complicated by scarring and previous failures.

Purpose of the Study:

  • To evaluate the efficacy of a free vascularized tensor fascia lata flap for knee extensor mechanism reconstruction.
  • To assess the outcomes in a complex, revisional surgical setting.

Main Methods:

  • A 59-year-old male patient underwent reconstruction using a free vascularized tensor fascia lata flap.
  • Submillimeter perforator-to-perforator anastomosis was utilized for vascular supply.
  • Novel techniques included dual-layer reinforcement and limited-incision harvest with tunneling.

Main Results:

  • The patient regained full knee extension at 12 months post-surgery.
  • A stable, pain-free gait was achieved.
  • The reconstructive procedure was performed successfully in a revisional (third surgery) setting.

Conclusions:

  • Free vascularized tensor fascia lata flap with perforator-to-perforator anastomosis is a viable option for extensor mechanism reconstruction.
  • This technique is particularly effective in complex, revisional cases with prior failures and scarring.