The anterior tibialis artery perforator (atap) flap for traumatic knee and patella defects: Clinical cases and anatomic study

Ariel N. Rad, Michael R. Christy, Eduardo D. Rodriguez, Philip Brazio, Gedge D. Rosson

Research output: Contribution to journalArticlepeer-review

Abstract

Soft-tissue reconstruction of traumatic patella and proximal tibial defects is challenging. Pedicled perforator-based adipocutaneous rotation flaps are a versatile local option as they have axial perfusion and greater freedom of transposition compared with random-pattern flaps, and replace the ideal tissue properties of this anatomic region.Experimental: Anatomic dissections were performed on 15 fresh cadaver legs and location of the dominant perforator measured. Clinical: A retrospective review was conducted at the University of Maryland/R Adams Cowley Shock Trauma Center evaluating patients over a 3-year period.Experimental: Cadaver dissections confirmed a principal perforator at 11.4 ± 1.6 cm inferior to the patella. This vessel is consistently suitable in length and caliber for large rotation flap design. Clinical: Anterior tibial artery perforator flaps were performed on 4 patients following Gustilo IIIB wounds to the patella and tibial plateau. Two patients had rotation flap reconstructions to salvage failed gastrocnemius muscle flaps. All flaps were successful, however, one patient had overwhelming hardware infection several months later despite successfully healed flap.Local anterior tibial artery perforator flaps based on predictable perforators provide reliable coverage of patella and knee defects, bestowing versatility and flexibility to the reconstructive surgeon's armamentarium.

Original languageEnglish (US)
Pages (from-to)210-216
Number of pages7
JournalAnnals of plastic surgery
Volume64
Issue number2
DOIs
StatePublished - Feb 1 2010

Keywords

  • Island pedicled flaps
  • Lower extremity reconstruction
  • Patella reconstruction
  • Perforator flaps
  • Propeller flaps
  • Tibial reconstruction
  • Tibialis anterior artery

ASJC Scopus subject areas

  • Surgery

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