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. Introduction:The gastrocnemius myofascial flap is used to manage soft-tissue defects overthe anterior aspect of the knee in the context of a patient presenting witha sinus and periprosthetic joint infection (PJI) or extensor mechanismfailure. The aim of this study was twofold: firstly, to evaluate theoutcomes of gastrocnemius flaps performed by appropriately trainedorthopaedic surgeons in the context of PJI and, secondly, to evaluate theinfection-free survival of this patient group.Patients and methods:We retrospectively reviewed 30 patients who underwent gastrocnemius flapreconstruction during staged revision total knee arthroplasty for prostheticjoint infection (PJI). All flaps were performed by an orthopaedic surgeonwith orthoplastics training. Patients had a mean age of 68.9 years (range50–84) and were followed up for a mean of 50.4 months (range 2–128 months).A total of 29 patients (97 %) were categorized into Musculoskeletal Infection Society (MSIS) local extremitygrade 3 (greater than two compromising factors), and 52 % of PJIs werepolymicrobial. The primary outcome measure was flap failure, and thesecondary outcome measure was recurrent infection.Results:Flap survival was 100 % with no failures or early returns to theatre forflap problems such as necrosis or haematoma. Overall infection-free survivalduring the study period was 48 % (13 of 27 infected cases). Usinglimb salvage as the outcome, 77 % (23 of 30 patients) retained the limb.Infection recurrence occurred in 48 % (10 patients) in the type B3 cohortand 67 % (4 patients) in the type C3 cohort (p=0.65).Conclusions:The surgical technique for a gastrocnemius myofascial flap is reliable andreproducible when performed by appropriately trained orthopaedic surgeons,even in high-risk groups. However, the risks of recurrent infection andamputation remain high within our series due to poor host and extremityfactors.

Outcomes of the gastrocnemius flap performed by orthopaedic surgeons in salvage revision knee arthroplasty