Knee extensor mechanism reconstruction with an extended gastrocnemius flap and a saphenous neurocutaneous flap

A 35-year-old woman had multiple fractures due to pedestrian versus motor vehicle accident by a truck. An open comminuted patellar fracture was initially managed with a tension band and cerclage wiring and primary closure of the wound. Other fractures were managed with proper internal fixation. Unfortunately, the fractured patella and overlying soft tissue became totally infected and a wide necrosis occurred. To control the wound, a complete debridement of dead tissue was undertaken and the patella and its tendon were removed, leaving a large bone and soft tissue defect on the knee joint. To reconstruct the extensor mechanism, an extended medial gastrocnemius flap including a tendinous portion of the Achilles was used. A saphenous neurocutaneous flap was simultaneously used for additional soft tissue coverage around the proximal tibia and remaining patellar tendon. At 12 months postoperatively, she showed complete extension, 135 degrees of flexion, and grade IV knee extensor power and was able to ambulate without a walking aid.