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Case Reports
. 2024 Jan 24;14(2):136.
doi: 10.3390/jpm14020136.

Pedicled Rectus Femoris Flap for Restoration of Suprapatellar Quadriceps Tendon and Defect Coverage after Multiple Reconstruction Attempts-A Case Report and Literature Review

Andrzej Hecker  1   2 , Nikolaus Watzinger  1 , Anna-Lisa Pignet  1   2 , Marlies Schellnegger  1 , Patrick Reinbacher  3 , Werner Girsch  1
Affiliations
Case Reports

Pedicled Rectus Femoris Flap for Restoration of Suprapatellar Quadriceps Tendon and Defect Coverage after Multiple Reconstruction Attempts-A Case Report and Literature Review

Andrzej Hecker et al. J Pers Med. .

Abstract

There is no unified approach for restoring the suprapatellar quadriceps tendon and covering tissue defects simultaneously. In this case report, we present the pedicled myocutaneous rectus femoris flap as one effective approach in two cases with extensive loss or impairment of the suprapatellar muscle-tendon structures after trauma-related suprapatellar quadriceps tendon rupture and multiple reconstruction attempts. Additionally, we provide a literature review of the reconstructive use of the functional pedicled myocutaneous rectus femoris flap.

Methods: Two male patients, 48 and 74 years old, with extensive loss or impairment of the suprapatellar muscle-tendon structures due to multiple reconstruction attempts, underwent restoration of the knee extension with a pedicled myocutaneous rectus femoris flap.

Results: Three months after reconstruction, both patients were able to walk freely, unaided. After a six-month follow-up, the free passive mobility of the knee joint was restored, and the active extension of the knee joint was possible in both patients.

Conclusion: The authors conclude that the pedicled rectus femoris flap is a reliable method for the restoration of knee extension, with excellent functional results in cases of suprapatellar tendon lesions. Further to the functional restoration, this technique has the additional advantage of simultaneously achieving coverage of soft-tissue defects, while a direct closure of the donor site is possible. Elderly patients and patients with relevant comorbidities or multiple revisions may especially benefit from this technique.

Keywords: functional reconstruction; pedicled rectus femoris flap; suprapatellar knee extensor.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
MRI showing overstretching of the knee extensor structures in patient 1.
Figure 2
Figure 2
Functional myocutaneous pedicled rectus femoris muscle for the restoration of knee extension and defect coverage after a complex tissue defect caused by multiple reconstruction attempts after a bicondylar femur fracture. (a) Complex suprapatellar wound healing disorder after the failure of soft tissue coverage with a local vastus medialis muscle and a split-thickness skin graft. (b) After debridement, the patella is exposed down to the patellar tendon and the mycutaneous femoris muscle flap is prepared. (c) Intraoperative view of the elevated rectus femoris muscle after dissection from its origin. Here, the rectus femoris flap stays attached only to its vascular pedicle. The rectus femoris muscle is attached distally to the patella with corkscrews. The vastus medialis and lateralis are refixed to the rectus femoris using non-resorbable sutures. (d) Finally, the skin island is inserted.
Figure 3
Figure 3
The patient was able to walk again without mobility aids 3 months after suprapatellar knee extensor reconstruction with a pedicled myocutaneous rectus femoris flap.
See this image and copyright information in PMC

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