The Reverse Biceps Femoris Muscle Flap: An Alternative Option for Soft-tissue Coverage Around the Popliteal Fossa

Area of Science:

• Orthopedic Surgery
• Reconstructive Surgery
• Trauma Management

Background:

• Reconstruction of the popliteal fossa presents significant challenges, especially with trauma or anatomical limitations.
• Traditional local flap options may be compromised in severe knee injuries, necessitating alternative reconstructive strategies.

Purpose of the Study:

• To present a case demonstrating the utility of a distally based biceps femoris muscle flap for soft-tissue coverage in the popliteal fossa.
• To illustrate an alternative reconstructive option for complex knee defects where standard flaps are not feasible.

Main Methods:

• A case of an 81-year-old female with Gustilo-Anderson type IIIB distal femur and tibial plateau fractures and knee dislocation was managed.
• Initial treatment involved external fixation and a lateral gastrocnemius flap, followed by development of a pressure wound.
• Subsequent reconstruction utilized knee arthrodesis with an intramedullary nail and soft-tissue coverage via a distally based biceps femoris long head transposition flap.

Main Results:

• The distally based biceps femoris long head flap successfully provided soft-tissue coverage for the pressure wound over the lateral femoral condyle.
• The flap's viability was maintained through its anastomotic connection with the short head of the biceps femoris.
• This reconstructive method proved effective in addressing complex soft-tissue defects around the knee.

Conclusions:

• The distally based biceps femoris long head transposition flap is a valuable technique for soft-tissue reconstruction around the popliteal fossa.
• This approach offers a reliable alternative when conventional muscle or perforator flaps are contraindicated or unavailable in severe knee trauma.