The Medial Sural Artery Perforator Island Flap as a Simpler Alternative for Prophylactic Skin Augmentation Prior to Total Knee Arthroplasty

Total knee arthroplasty is a common orthopaedic procedure of great benefit in restoring unimpeded and pain free ambulation with rare complications [1]. However, subsequent soft tissue compromise and/or joint infection can be disastrous if prosthesis salvage is impossible requiring instead knee fusion or even amputation [1]. The pre-operative presence of tenuous soft tissues, most obvious if a skin graft covers the knee region; or the existence of multiple or problematic scars should be indications for consideration of prophylactic soft tissue replacement with a flap so as to avoid these endpoints [1, 2]. This is a proven and beneficial concept where usually the medial gastrocnemius muscle or distal-based anterolateral thigh flap as a local flap has been selected, or else even a free tissue transfer [1–3]. With the advent of perforator-based cutaneous pedicled flaps, the medial sural artery perforator flap as a local island flap should be considered as another alternative to fulfill this orthoplastic approach for minimizing untoward events [4].