A clinical case of using the concept of monitoring in the treatment of a gunshot defect of the soft tissues of the knee joint





perforator flap, gunshot defects of the lower extremities, reconstruction


Rapid rehabilitation and restoration of the function of damaged anatomical areas in the military is the main goal of military medicine. In the case of gunshot wounds of the knee joint with defects of soft tissues, one of the optional methods of reconstructive and plastic "closure" is the usage of a propeller flap. The clinical case represents a mine-explosive wound of the lower extremities with a defect of the soft tissues of the lateral aspect of the right knee joint in a serviceman of the Ukrainian Armed Forces as a result of artillery shelling in the east of Ukraine in November 2022. There was an isolated shrapnel tangential non-penetrating wound on the lateral aspect of the right knee joint with a soft tissue defect measuring 7.2x3.2-1.0 cm. The aim of the work was to study the thermographic and sonographic features of soft tissue perfusion after gunshot injuries of the lower extremities and on the basis of the temperature dynamics data from the wound surface in combination with the sonographic examination of the vessels to determine the rationality and relevance in the reconstruction of defects of the lower extremities by propeller tactics. Reconstruction with flap with a perforating vessel as the "key" of LSGA (lateral superior genicular artery) and a dynamic multimodal concept (DMT) with the use of audio doppler in the pre-, intra- and postoperative period) with closure of the defect due to a rotary perforating flap with supplying was carried out. During the entire period of treatment, of the injured the temperature background from the surface of the flap was followed up using FLIR C2, and sonographic changes in blood flow were monitored in the projection of the LSGA location. We came to the conclusion that applying the technique of flaps on perforating vessels, several goals are tactically achieved: restoration of the completeness and function of the damaged area, reduction of complications in the recipient and donor areas. Thus, the propeller flap can be classified as a primary option for "replacemen t" of tissues among the restorative tactics of the damaged area of the lower extremities caused by a gunshot origin.


Korol SO, Khomenko IP, Matviichuk BV, Ustinova LA. [Surgical tactics of treatment of the wounded with gunshot wounds of the thigh at all levels of medical support]. Klinichna khirurhiia. 2019;5(86):22-6. Ukrainian. doi: https://doi.org/10.26779/2522-1396.2019.05.22

Khomenko IP. [Instruction on medical support of the Armed Forces of Ukraine for a special period]. Kyiv: «Vydavnytstvo Liudmyla»; 2019. 192 р. Ukrainian.

Kosutic D. Hybrid perforator flaps: Introducing a new concept in perforator flap surgery. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2020;73:764-9. doi: https://doi.org/10.1016/j.bjps.2019.11.007

Tenekeci G. Perforator Flaps: Principles and Techniques. [Internet]. 2017 [cited 2022 Oct 09]. doi: https://doi.org/10.5772/intechopen.71270

Koshima I. Perforator flaps concept, history and evolution of the use of anterolateral thigh flap (ALT). Reconstructive and plastic surgery issues. 2020;73(2):5-12.

Hallock GG. The propeller flap version of the adductor muscle perforator flap for coverage of ischial or trochanteric pressure sores. Ann Plast Surg. 2006; 56:540-2. doi: https://doi.org/10.1097/01.sap.0000210512.81988.2b

O-Wern Low, Tian Fu Loh, Hanjing Lee, Yan Lin Yap, Jane Lim, Thiam Chye Lim, et al. The superior lateral genicular artery flap for reconstruction of knee and proximal leg defects. Arch Plast Surg. 2022;49(01):108-14. doi: https://doi.org/10.5999/aps.2021.01123

Yadav P, Thakur S, Agarwal P, Sharma D, Kukrele R. Perforator-based propeller flap for coverage of lower leg: Single centre experience. Tropical Doctor. 2021;51(3):331-8. doi: https://doi.org/10.1177/0049475520988225

Sapino G, Gonvers S, Cherubino M, di Summa PG. The "Sombrero-Shape" Super-Thin Pedicled ALT Flap for Complete Scrotal Reconstruction Following Fournier's Gangrene. Arch Plast Surg. 2022 May 27;49(3):453-6. doi: https://doi.org/10.1055/s-0042-1748663

Kishk TF, Elbarah AM, Elsheikh YM, et al. The assessment of the clinical applications of propeller flaps of the lower leg. Menoufia Med J. 2016;29:580-6. doi: https://doi.org/10.4103/1110-2098.198717

Blondeel P, Morris S, Hallock G, Neligan P. Perforator Flaps Anatomy, Technique, & Clinical Applications. Second Edition. St. Louis, Missouri; 2013. p. 669-70, 675.

Pavlov S, Litvinova O, Mikhaylusov R, Negoduyko V, Kumetchko M, Semko N. Healing Features of Experimental Injuries of Soft Tissues That Contain Foreign Bodies In The Form of Fragments Of Military Personnel Uniforms. BMJ Military Health. 2023 May;169(e1):e59-e63. doi: https://doi.org/10.1136/bmjmilitary-2020-001666

Ling BM, Wettstein R, Staub D, et al. The medial sural artery perforator flap: the first choice for soft-tissue reconstruction about the knee. J Bone Joint Surg Am. 2018;100:211-7. doi: https://doi.org/10.2106/JBJS.16.01401



How to Cite

Lurin I, Khomenko I, Khoroshun E, Nehoduiko V, Tertyshnyi S, Kosynskyi O, Buzmakov D, Weiss B. A clinical case of using the concept of monitoring in the treatment of a gunshot defect of the soft tissues of the knee joint. Med. perspekt. [Internet]. 2023Jun.30 [cited 2024Jul.21];28(2):197-20. Available from: https://journals.uran.ua/index.php/2307-0404/article/view/283427