The role of gastrocnemius muscle flap for reconstruction of
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The surgical management of infected total knee arthroplasty remains a challenging therapeutic problem. The two-stage management has proven to be the reliable method of choice. The use of the gastrocnemius muscle flap has become a great ""classic"" for coverage of large soft tissue defects of the knee and proximal third of lower leg. A short review of literature including two short case presentations will highlight that procedure with or without required removal of implant and the specificities of the use of medial or lateral gastrocnemius muscle head are shown.
Case 1:
A 76-year-old male presented with a chronic and deep high-grade TKA. Assessment by culture and histology revealed bacterial load with multiresistant Staphylococcus aureus. First: the implant was removed, accompanied with multiple debridements and incorporation of a polymethyl methacrylate (PMMA) spacer containing vancomycin, and multiple negative-pressure vacuum assisted closure (VAC) therapies of the resulting large soft tissue defect. Second: after consolidation of deep infect, assessed by culture and histology, the defect was covered with the use of a medial gastrocnemius muscle flap, and additional split-thickness skin grafts. After that, the wound healing was uncomplicated; and eight weeks after the first step of surgical intervention, a new TKA could be performed. Six months after insertion of the new TKA, the function was satisfactory, and the patient could be mobilized with full weight-bearing on the affected leg.

Case 2:
An 85-year-old female presented with an acute and low-grade revision TKA infection right, assessment by culture and histology revealed bacterial load with Staphylococcus epidermidis. The TKA was done six weeks ago due to a pronounced primary osteoarthritis.Primary surgical treatment consists of multiple debridements, incorporation of collagen drug carriers containing gentamycin, multiple negative-pressure VAC therapies, and the revision TKA was not removed. Second: after consolidation of low-grade infect, assessed by culture and histology, the defect was covered with the use of a lateral gastrocnemius muscle flap, and additional split-thickness skin grafts. After that, the wound healing was uncomplicated and the patient could be mobilized with full weight-bearing on the affected leg....

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