Knee joint reconstruction using regional flaps: an aesthetic approach to extensive defects following fourth-degree contact burns

The reconstruction of complex and extensive defects involving the knee joint represents an aesthetic and functional challenge. The knee joint is one of the most complex structures of the body in terms of dimensional architecture, thickness, reliability, and its functional role. Defects affecting the total thickness of the knee joint have negative effects on patients’ social function, quality of life, physical health, and satisfaction with their appearance when wearing shorts. Therefore, aesthetic outcomes after the coverage of soft tissue defects for reconstruction are important. Soft tissue coverage for defects around the knee joint has been performed using different types of pedicled flaps and free flaps [1]. Gastrocnemius muscle flaps have been used for decades to reconstruct defects of the proximal tibia and knee caused by trauma, tumors, and infections around the knee, and to reconstruct extensor mechanism discontinuities with and without total joint arthroplasty [2]. Furthermore, antegrade peroneal fasciocutaneous flaps may be useful for reconstruction of the inferior knee joint. Herein, the authors report a case of a fourth-degree contact burn on the knee joint that was reconstructed using medial and lateral gastrocnemius muscle flaps, pedicled anterolateral thigh flap, peroneal fasciocutaneous flap, and split-thickness skin grafts (SSGs) harvested from the scalp and thigh. Four types of pedicled flaps were needed because this patient had an extensive, deep defect in the right knee joint, which is an exceedingly rare condition.