Retalhos de rotação para cobertura após artroplastia total de joelho

Abstract

OBJECTIVE: To evaluate the results obtained using local myocutaneous rotation flaps in cases of wound dehiscence after total knee arthroplasty. METHODS: Patients undergoing these surgical procedures were selected in the 2000-2012 period. The nine selected cases during this period were subjected to flap coverage due to skin dehiscence associated with infection. In eight cases we used rotation flaps of the medial gastrocnemius, and in one case we used advancing skin. RESULTS: Eighty nine percent of the cases were successful in the coverage of the prosthesis and the viability of the flaps. In four cases it was possible to maintain or review the prosthesis. Four other cases progressed to amputation due to failure on treatment of infections, and one case remained without the prosthesis. The functional evaluation showed an unsatisfactory outcome in 89% of cases. CONCLUSION: Coverage flaps are a good option for the treatment of cases of dehiscence with exposure of the prosthesis and the functional failure was associated with the inability to control the infection and the damage it caused. Level of Evidence IV, Case Series.

Systematic Review and Comparative Meta-Analysis of Outcomes Following Pedicled Muscle versus Fasciocutaneous Flap Coverage for Complex Periprosthetic Wounds in Patients with Total Knee Arthroplasty

“…The mean postoperative knee motion among the 55 patients who underwent gastrocnemius flap coverage was 98.5° [2627282933343637]. These values, however, were not compared to preoperative baseline levels.…”

“…Following the application of the exclusion criteria, 18 articles were ultimately deemed appropriate for analysis ( Fig. 7 ) 16 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 . Of these 18 articles, 16 were case series and 2 were case reports.…”

Short- and Long-Term Complications of Free Anterolateral Thigh Flap Reconstructions: A Single-Centre Experience of 92 Consecutive Cases

“…More extensive defects involving the loss of parts of bone, muscle, fascia, and overlying soft tissues secondary to trauma or sarcoma resections are most commonly covered using musculocutaneous flaps such as the gastrocnemius muscle, vastus medialis or lateralis muscle flap, or the reversed biceps femoris flap [ 20 , 21 ]. Despite their easy availability and associated short operating time, these flaps have been shown to be too bulky which compromises cosmesis and functionality [ 22 ].…”

Effect of postoperative use of nasal oxygen catheter supplementation in wound healing following total knee arthroplasty

“…Oxygen tension then remains below normal (decreased by 16%) until the end of the first week post-surgery. Oxygen supplementation through the nose (24% oxygen) increases the skin tissue oxygenation to preoperative levels after only five minutes of application 6 . O'Connor 10 recommended postoperative oxygen supplementation for several days following TKA in patients with a high risk of healing problems.…”

“…Because of the aging of the population and the significant increase in the number of TKA procedures performed worldwide, the number of complications inherent to this procedure is also increasing 2 , 3 . Complications related to operative wounds have high morbidity rates and can rapidly evolve into local infectious processes that are difficult to treat 4 - 6 . These complications may be local or systemic and depend on many factors related to the patient, the environment and the surgical technique 7 .…”