Management of exposed total knee prostheses with microvascular tissue transfer

Cetrulo, Curtis L.; Shiba, B S Travis; Friel, Michael T.; Davis, Brian L.; Buntic, Rudolph; Buncke, Gregory M.; Brooks, Darrell

doi:10.1002/micr.20578

Cited by 39 publications

(33 citation statements)

References 64 publications

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“…13,14 Muscle-based flaps are also known to provide an adequate tissue mass for eliminating dead space as well as the skin defect in cases of oncologic hemipelvectomy defects. 15 Muscle-based flaps have proven to be of great value in the reconstruction of complex wounds, primarily because of their rich vascular supply and superior resistance to infection.…”

Section: Discussionmentioning

confidence: 99%

Treatment of pelvic defect and infection with endoprosthesis exposure by topical negative pressure and irrigation with myocutaneous flap

2011

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The treatment of wound complications and deep infection after hemipelvectomy is challenging. We describe a 17-year-old woman with Ewing sarcoma in the pelvis who underwent hemipelvectomy and reconstruction with an artificial hip joint and bone cement. After the operation, skin necrosis and deep infection with methicillin-resistant Staphylococcus aureus (MRSA) were observed. Debridement resulted in exposure of the artificial joint and bone cement. Topical negative pressure (TNP) and irrigation successfully eradicated the infection. The skin and soft-tissue defect was subsequently reconstructed using a combination of free latissimus dorsi myocutaneous flap and serratus anterior muscle flap. To our knowledge, this is the first described case of combined TNP and irrigation with myocutaneous flap for the treatment of pelvic infection and skin and soft-tissue defect with endoprosthesis exposure.

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Section: Discussionmentioning

confidence: 99%

Treatment of pelvic defect and infection with endoprosthesis exposure by topical negative pressure and irrigation with myocutaneous flap

2011

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“…In patients with symptoms of infection, treatment consisting of irrigation, débridement, systemic antibiotic therapy, and immediate soft-tissue coverage has been associated with high rates of retention of the prosthesis. 15–18 In patients with chronic deep periprosthetic infections, implant revision with long-term antibiotic therapy is recommended. Debate exists as to whether a single-stage revision or a two-stage revision with delayed reimplantation and the use of an antibiotic spacer or cement during the interval between stages leads to improved results.…”

Section: Initial Interventionmentioning

confidence: 99%

“…The latissimus dorsi free flap and the rectus abdominis free flap have both been used for coverage of soft-tissue defects with excellent limb salvage rates (>90%) in infected knees with an exposed prosthesis after TKA. 16,18 The latissimus dorsi free flap can be harvested with a muscle dimension of 20 × 35 cm and with an overlying elliptic skin paddle of 9 × 25 cm that allows primary closure of the donor site. It is raised on a vascular pedicle containing the thoracodorsal artery, which allows for a length of 7 to 12 cm.…”

Section: Management Optionsmentioning

confidence: 99%

Soft-tissue Defects After Total Knee Arthroplasty: Management and Reconstruction

Osei

Rebehn

Boyer

2016

J Am Acad Orthop Surg

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Wound healing complications associated with total knee arthroplasty present a considerable challenge to the orthopaedic surgeon. To ensure preservation of a functional joint, the management of periprosthetic soft-tissue defects around the knee requires rapid assessment, early and aggressive débridement, and durable, contoured coverage. Several reconstructive options are available to tailor soft-tissue coverage to the location, size, and depth of the wound. Special consideration should be given to the timing of the intervention, management of infection, and prosthesis salvage. The merits of each reconstructive option, including perforator, fasciocutaneous, muscular, and free microvascular flaps, should be weighed to select the most appropriate option. The proposed approach can guide surgeons in treating patients with these complex soft-tissue defects.

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“…First one is the complication management indication which means impaired wound healing after implantation of prosthesis. [11][12][13][14][15] Second one is the prophylactic indication, which is valid in case of possible soft tissue insufficiency. 1,[16][17][18][19] However, to the best of our knowledge, there are not too much series regarding the second indication in literature.…”

mentioning

confidence: 99%

Soft‐tissue management with immediate free flap transfer in segmental prosthetic replacement of proximal tibia sarcomas

et al. 2011

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Knee reconstruction with endoprosthesis after tumor resection is accepted as superior when compared with the other methods. But sometimes soft tissue reconstruction would be a challenging problem in this way of treatment. Five patients who were operated for tumor resection in this location, followed by reconstruction were presented with their one-year post operative results. Four latissimus dorsi and one rectus abdominis myocutaneous free flaps were used in these patients in order to manage soft tissue problems. All patients underwent chemotherapy in postoperative period. All flaps were successful in one year post operative examination. In this report we would like to stress the importance of surgical planning and soft tissue reconstruction of a specific patient population. We think that large musculocutaneous flaps such as latissimus dorsi and rectus abdominis musculocutaneous flaps should be preferred in soft tissue reconstruction of knee region after tumor resection followed by prosthetic replacement. Additionally, this way of treatment is superior when compared to the other methods in order to prevent complications such as prosthesis exposure or infection.

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Management of exposed total knee prostheses with microvascular tissue transfer

Cited by 39 publications

References 64 publications

Treatment of pelvic defect and infection with endoprosthesis exposure by topical negative pressure and irrigation with myocutaneous flap

Treatment of pelvic defect and infection with endoprosthesis exposure by topical negative pressure and irrigation with myocutaneous flap

Soft-tissue Defects After Total Knee Arthroplasty: Management and Reconstruction

Soft‐tissue management with immediate free flap transfer in segmental prosthetic replacement of proximal tibia sarcomas

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