Reconstructive SurgeryProphylactic Flap Reconstruction of the Knee Prior to Total Knee Arthroplasty in High-Risk PatientsCasey, William J. III MD*; Rebecca, Alanna M. MD*; Krochmal, Daniel J. MD†; Kim, Hahns Y. MD*; Hemminger, Betsy J. PA-C*; Clarke, Henry D. MD‡; Spangehl, Mark J. MD‡; Smith, Anthony A. MD*Author Information From the *Division of Plastic and Reconstructive Surgery, Mayo Clinic Arizona, Phoenix, AZ; Departments of †Surgery and ‡Orthopedic Surgery, Mayo Clinic Arizona; Phoenix, AZ. Received January 18, 2010, and accepted for publication, after revision, April 18, 2010. Presented at the 55th annual meeting of the Plastic Surgery Research Council; San Francisco, California, May 25, 2010. To be presented at the European Association of Plastic Surgery (EURAPS) annual meeting; Manchester, United Kingdom, May 28, 2010. The authors have no conflicts of interest or financial relationships to disclose in the preparation, presentation, or submission of this manuscript. Reprints: William J. Casey, III, MD, Division of Plastic and Reconstructive Surgery, Mayo Clinic Arizona, 5777 E. Mayo Boulevard, Phoenix, AZ 85054. E-mail: [email protected]. Annals of Plastic Surgery: April 2011 - Volume 66 - Issue 4 - p 381-387 doi: 10.1097/SAP.0b013e3181e37c04 Buy Metrics Abstract Insufficient soft-tissue coverage following total knee arthroplasty (TKA) may threaten prosthesis retention or compromise joint function. A retrospective review was conducted of all patients who underwent prophylactic flap reconstruction of the knee prior to TKA or salvage flap reconstruction over a 6-year period. Twenty-three patients underwent prophylactic flap reconstruction. Complications at the time of flap transfer were common (48%), however, all flaps survived. All 23 successfully completed subsequent TKA with no wound complications occurring at the time of TKA. Complications in the salvage group were also frequent (44%) and 3 required above knee amputation. Postoperative range of motion was significantly better in the prophylactic group, as well as when cutaneous flaps were chosen. Prophylactic flap reconstruction of the knee prior to TKA in high-risk patients is an excellent option in this small subset of patients, many of whom would not be offered TKA without addressing the compromised soft-tissue envelope first. © 2011 Lippincott Williams & Wilkins, Inc.