Knee Region Coverage with Reversed Gracilis Pedicle Flap (GReSP Flap)

To treat severe soft-tissue complications of total knee arthroplasty, we used an extended reversed gracilis flap based on secondary pedicles (the GReSP flap). Locate the gracilis and pedicles, then debride the wound bed. Expose the superficial aspect of the muscle, while protecting the saphenous vein and nerve. Temporarily clamp the main vascular pedicle to ensure blood supply when perfused only by the secondary pedicles. Transect the proximal tendon of the gracilis muscle to provide maximal length for the muscle flap and ligate the main vascular and nerve pedicles. Suture the flap in place and cover with skin graft. Immobilize the knee for two weeks; follow with rehabilitation to restore range of motion. We treated three patients who had an infection at the site of a total knee arthroplasty and exposure of the implant. IndicationsContraindicationsPitfalls & Challenges.