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Reversed Gracilis Pedicle Flap for Coverage of a Total Knee Prosthesis*
C. Tiengo, MD1; V. Macchi, MD1; E. Vigato, MD1; A. Porzionato, MD1; C. Stecco, MD1; B. Azzena, MD1; A. Morra, MD1; R. De Caro, MD1
1 Section of Anatomy, Department of Human Anatomy and Physiology, School of Medicine, University of Padova, Via A Gabelli 65, 35127 Padova, Italy. E-mail address for C. Tiengo: tiengo@iname.com. E-mail address for V. Macchi: veronica.macchi@unipd.it. E-mail address for E. Vigato: enricovigato@yahoo.it. E-mail address for A. Porzionato: andrea.porzionato@unipd.it. E-mail address for C. Stecco: carla.stecco@unipd.it. E-mail address for B. Azzena: bruno.azzena@sanita.padova.it. E-mail address for A. Morra: aldo.morra@euganeamedica.it. E-mail address for R. De Caro: rdecaro@unipd.it
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at the Section of Anatomy, Department of Human Anatomy and Physiology, School of Medicine, University of Padova, Padova, Italy
Presented at the Meeting of the Italian Society of Microsurgery, Milan, October 2007, and at the Winter Meeting of the British Association of Clinical Anatomists at King's College, London, December 2007.

Copyright ©2010 American Society for Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Jul 07;92(7):1640-1646. doi: 10.2106/JBJS.I.00195
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Poor wound-healing and skin necrosis are potentially devastating complications after total knee arthroplasty. Primary soft-tissue coverage with a medial or lateral gastrocnemius transposition flap is typically the first choice for reconstruction. The aim of this study was to evaluate the use of a distally based secondary-pedicle flap of the gracilis muscle for reconstruction of a soft-tissue defect.


The characteristics of the distally based (secondary) pedicles of the gracilis muscle were studied with use of dissection (ten cadavers) and computed tomographic angiograms (fifty patients). On the basis of the anatomical features, an extended reversed gracilis flap based on the secondary pedicles was used in three patients with severe soft-tissue complications of total knee arthroplasty.


The mean number of secondary pedicles was 1.8 (range, one to four). The pedicles originated from the superficial femoral or popliteal artery. The most proximal pedicle was often the largest (mean caliber, 2.0 mm), and its point of entry into the gracilis muscle was an average (and standard deviation) of 21 ± 3.6 cm (range, 16 to 28 cm) from the ischiopubic branch. A significant positive association (p = 0.001; r2 = 0.49) was found between the caliber of the proximal secondary pedicle and the number of other secondary pedicles. In all three patients, the adequate caliber of the secondary pedicles (as shown on preoperative computed tomographic angiograms) and good muscle vascularization confirmed the utility of the gracilis as a distally based pedicle flap.


For the treatment of large soft-tissue defects of the patella or the proximal part of the knee, or for soft-tissue reconstruction over an exposed total knee prosthesis, the reversed gracilis pedicle flap may be an alternative to, or may be integrated with, a lateral or medial gastrocnemius flap.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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