Reconstruction of Extensor Mechanism Defect with Sartorius Muscle Transfer

Description

In this detailed surgical video, Dr. Janet Conway presents the complex case of an 81-year-old gentleman who has undergone multiple surgeries for a quadriceps tendon rupture sustained during weightlifting. In April, he initially ruptured the tendon, which was surgically repaired, but sustained a re-rupture in September requiring a second repair. By November, he presented with a chronic infection at the surgical site, resulting in a need for debridement to remove infected tissue.



Dr. Conway outlines a comprehensive surgical plan, which involves first performing a debridement to clean the wound and prepare for a second-stage surgery that will involve a sartorius muscle transfer to enhance the reconstruction of the quadriceps tendon. Key moments in the operation highlight the critical steps taken to ensure proper exposure, cleaning out infected granulation tissue, and the importance of using monofilament sutures to mitigate the risk of further infection from braided materials.



Throughout the procedure, Dr. Conway emphasizes the intricacies of maintaining blood flow to the area and minimizing complications associated with tissue ischemia. After cleaning and preparing the wound, she discusses the harvesting of healthy sartorius muscle tissue to use as a living graft, ensuring care is taken to preserve blood supply.



The final steps include suturing the transferred muscle to the patella and ensuring proper tension without compromising blood flow. Throughout the surgery, Dr. Conway offers insights into surgical techniques and decisions made based on the patient's prior medical history, such as his repeated infections, which are closely monitored during the entire process.



Following the reconstruction, a detailed post-operative care plan is outlined, including instructions for immobilization, vigilance against infection, pain management, and the importance of gradual weight-bearing as the site heals. The video illustrates the resilience and collaborative efforts of the surgical team in restoring function to the patient's injured leg.

Specialties