M. Governa Æ A. Tambuscio Æ A. Dall’Antonia
The posterior calf fasciocutaneous island ﬂap in the covering
of infected traumatic defects of the knee
Received: 3 June 2004 / Accepted: 1 July 2004 / Published online: 27 January 2005
Ó Springer-Verlag 2005
Abstract Our experience with the posterior calf fascio-
cutaneous island ﬂap in the treatment of 12 traumatic
knee lesions is presented. The wide vascular fascial
pedicle provided a good blood inﬂow and all the ﬂaps
survived. The postoperative complications were mild,
and the functional result was satisfactory even in cases
associated with ligament tissue loss.
Keywords Knee traumatic defects Æ Posterior calf ﬂap Æ
Open trauma of the knee region is often complicated by
deep infections involving articular structures leading to
their exposure. Thus, the prognosis becomes worse, and
the time involved in healing is delayed.
Early cover of these very complicated lesions is
therefore basic in order to achieve complete functional
recovery of the joint .
The dynamics of inferior limb traumatic injuries more
often involve the anterior and lateral soft tissues,
therefore the chances of reconstruction using local ﬂaps
are considerably limited. Frequently, the posterior sur-
face of the leg is the only potential donor area for the
defect repair [14, 15].
Many reconstructive techniques have been suggested
(i.e., cross leg and muscular or myocutaneous ﬂaps of
the leg or the thigh) [2, 3, 5, 8, 10, 21, 23, 25, 32].
In 1981, Ponten demonstrated the excellent blood
supply of fasciocutaneous ﬂaps [22, 26], comparable to
that provided by the most important muscular and
myocutaneous ﬂaps. These ﬁndings conﬁrmed the pre-
vious studies of Bakamjian and others [6, 7, 13, 35, 36].
Posterior leg skin is supplied by two main vascular
systems: the ﬁrst being a suprafascial and subfascial
plexus fed by penetrating vessels from the muscle; the
second being a subcutaneous vessel system. These two
patterns are linked in the deep fascia and are partially
independent from each other [7, 13, 35, 36]. Including
the deep fascia in the skin ﬂap, therefore, favors surface
vascularization, reducing the risk of damaging the su-
prafascial superﬁcial vessels [4, 7, 9, 13, 35].
There are three main vessels in this region: the lateral,
median, and medial sural arteries, coming from the
popliteal artery or from the lateral inferior genicular
artery [19, 30] (Fig. 1). Most recent anatomic studies
seem to prove that the lateral and median sural arteries
are the main ones [7, 9, 13, 14, 33]. This can explain why
the posterior calf fasciocutaneous island ﬂap has been
used with a median or lateral pedicle, or with a wide
fascial pedicle including all of the arterial supply [6, 17,
22, 27]. Our experiences with this ﬂap in the recon-
struction of exposed knee lesions is reported.
Material and methods
Twelve patients (three females, nine males) were treated
with a posterior calf fasciocutaneous island ﬂap for
complex post-traumatic knee lesions. In one case, there
was exposure of the knee prosthesis; in the other patients
the joints were exposed. Two cases were complicated by
patella-related tendon loss. In each case, preoperative
bacteriology with Abg was performed in order to get the
proper antibiotic therapy.
During surgery the necrotic tissues were removed
and the defect covered with a posterior calf fasciocu-
taneous island ﬂap (Fig. 2). The donor area was skin-
grafted. In those cases in which a patellar ligament le-
Presented at the 15th annual meeting of the European Association
of Plastic Surgeons (EURAPS), Genoa, Italy, 27–29 May 2004.
M. Governa (&) Æ A. Tambuscio Æ A. Dall’Antonia
First Division of Plastic Surgery and Burn Center,
Verona Hospital, Verona, Italy
Eur J Plast Surg (2005) 27: 322–326