{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:22:10Z","timestamp":1789345330625,"version":"build-2803163510"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,2,6]],"date-time":"2023-02-06T00:00:00Z","timestamp":1675641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Free tissue transfer to the knee region in patients with chronic post-traumatic knee osteomyelitis (CTKOM) poses a great challenge to surgeons because the remaining soft tissues adjacent to defects, including vascular structures, are usually damaged by chronic inflammation and multiple debridements. Thus, we developed an algorithm to help select the optimal recipient vessels and appropriate anterolateral thigh perforator (ALTP) flap type. In addition, we performed surgery using this algorithm and achieved successful reconstructions. This study aims to review our experiences in algorithmic reconstruction and assess its efficacy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>According to the defect size and location, our algorithm suggested the use of various-shaped ALTP flaps with centrally located perforators (Cen-ALTP flap) or eccentrically located perforators (Ecc-ALTP flap). Besides, through the algorithm, one recipient vessel was selected among three candidates, including descending branch of the lateral circumflex femoral artery (DB-LCFA), anterior tibial artery (ATA), and posterior tibial artery (PTA). Based on this algorithmic decision, we performed individualized soft tissue reconstructions of the knee in 21 patients with CTKOM, between March 2013 and June 2021. The medical records of the patients were retrospectively reviewed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The Cen-ALTP flap (<jats:italic>n<\/jats:italic>\u2009=\u200915) and ATA (<jats:italic>n<\/jats:italic>\u2009=\u20099) were the most commonly used for reconstruction. The Cen-ALTP flap anastomosed to the ATA was most commonly selected (<jats:italic>n<\/jats:italic>\u2009=\u20097) using the algorithm, followed by the Cen-ALTP flap anastomosed to the DB-LCFA (<jats:italic>n<\/jats:italic>\u2009=\u20095), and the Cen-ALTP flap anastomosed to the PTA (<jats:italic>n<\/jats:italic>\u2009=\u20093). All transferred ALTP flaps survived the follow-up period. Postoperative venous congestion in two patients and hematoma in one patient were resolved by immediate treatment. The postoperative course was uneventful.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>During free ALTP flap transfer to CTKOM-related knee defects, we could select the optimal recipient vessel and appropriate flap type using our algorithm and obtain excellent reconstructive outcomes. Therefore, we believe that our algorithm could provide helpful guidance to reconstructive surgeons on free ALTP flap transfer to reconstruct CTKOM-related soft tissue defects.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2023.982669","type":"journal-article","created":{"date-parts":[[2023,2,6]],"date-time":"2023-02-06T04:52:59Z","timestamp":1675659179000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["An algorithmic approach to soft-tissue reconstruction around the knee using anterolateral thigh perforator flap in patients with post-traumatic knee osteomyelitis"],"prefix":"10.3389","volume":"10","author":[{"given":"Seong-Ho","family":"Jeong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung-Hee","family":"Baik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sik","family":"Namgoong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun-Sang","family":"Dhong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung-Kyu","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,2,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"837","DOI":"10.2106\/JBJS.N.01350","article-title":"Trends in the epidemiology of osteomyelitis: a population-based study, 1969 to 2009","volume":"97","author":"Kremers","year":"2015","journal-title":"J Bone Joint Surg Am"},{"key":"B2","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1186\/s12879-018-3550-6","article-title":"Factors predictive of relapse in adult bacterial osteomyelitis of long bones","volume":"18","author":"Garcia Del Pozo","year":"2018","journal-title":"BMC infect dis"},{"key":"B3","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1302\/0301-620X.95B11.32836","article-title":"Wound healing in total joint replacement","author":"Jones","year":"2013","journal-title":"Bone Joint J"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1349","DOI":"10.1111\/iwj.13729","article-title":"Clinical study on orthopaedic treatment of chronic osteomyelitis with soft tissue defect in adults","volume":"19","author":"Zhang","year":"2022","journal-title":"Int Wound J"},{"key":"B5","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1097\/SAP.0b013e31828d7558","article-title":"Free flap reconstruction of the knee: an outcome study of 34 cases","volume":"74","author":"Louer","year":"2015","journal-title":"Ann Plast Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1097\/00003086-199811000-00017","article-title":"Salvage procedures for complex soft tissue defects of the knee","volume":"356","author":"Nahabedian","year":"1998","journal-title":"Clin Orthop Relat Res"},{"key":"B7","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1002\/micr.20752","article-title":"Portable duplex ultrasonography: a diagnostic and decision-making tool in reconstructive microsurgery","volume":"30","author":"Gravvanis","year":"2010","journal-title":"Microsurgery"},{"key":"B8","doi-asserted-by":"publisher","first-page":"603","DOI":"10.5312\/wjo.v5.i5.603","article-title":"Flap reconstruction of the knee: a review of current concepts and a proposed algorithm","volume":"18","author":"Gravvanis","year":"2014","journal-title":"World J Orthop"},{"key":"B9","doi-asserted-by":"publisher","first-page":"970","DOI":"10.1097\/00006534-199909040-00011","article-title":"Influence of recipient vessels on free tissue transplantation of the extremities. 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