Muscle-Flap Coverage of Exposed Endoprostheses

Lesavoy, Malcolm A.; Dubrow, Terry J.; Wackym, Phillip A.; Eċkardt, Jeffrey J.

doi:10.1097/00006534-198901000-00017

Cited by 43 publications

(25 citation statements)

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“…Some authors defined postoperative infection as the presence of purulent fluid (Lesavoy et al 1989), while others required positive wound cultures for the diagnosis (Hochberg et al 1998). One study gave a more strict definition of deep infection, requiring clinical signs of infection with positive bacterial cultures together with intraoperative findings of infection spreading into the hardware (Johnson et al 1986).…”

Section: Definition Of Ssimentioning

confidence: 99%

Complications in ankle fracture surgery

Ovaska¹

2015

Acta Orthopaedica

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Section: Definition Of Ssimentioning

confidence: 99%

Complications in ankle fracture surgery

Ovaska¹

2015

Acta Orthopaedica

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“…This would include: Flaps containing muscle have also been shown to have a beneficial effect in infection. Muscle and musculocutaneous flaps have been used for cover of exposed prostheses [1,5]. In this series the patients who underwent muscle or musculocutaneous flaps had better result than patients with other flaps.…”

Section: Discussionmentioning

confidence: 99%

Role of staged endoprosthetic revision with flap cover for limb salvage in endoprosthetic failure

Rao

Lahiri

Peart³

2006

International Orthopaedics (SICOT)

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Endoprosthetic replacement (EPR) is commonly required for limb salvage in bone malignancies. Endoprosthetic failure is a term used to denote mechanical failure or infection usually requiring removal of the prosthesis. Treatment of infection consists of EPR revision with or without placement of a temporary spacer. Flap cover (either local or free) may be required if the overlying soft tissues are of concern. It is claimed that the investment of the endoprosthesis in well-vacularised soft tissue facilitates the eradication of infection. This series included nine patients with endoprosthetic failure due to chronic infection who needed flap cover. These patients underwent revision of the EPR in two stages. The first stage of revision included removal of the endoprosthesis, insertion of a spacer and soft tissue reconstruction. If serial sampling of the periprosthetic space failed to demonstrate microbial growth, the spacer was exchanged for an endoprosthesis.A total of nine patients underwent staged revision of endoprosthesis. In five patients cover was provided by a local pedicled flap and in four by a free flap. Patients undergoing cover by a broad flat musculocutaneous flap (i.e. free/pedicled latissimus dorsi) performed better. This study reports the results of attempted limb salvage in endoprosthetic failure due to infection in nine cases. Initial findings in this small series indicate that staged revision and soft tissue reconstruction in the form of muscle flap investment of the endoprosthesis carries a higher rate of successful limb salvage.Résumé Le remplacement prothètique est fréquemment utilisé pour la chirurgie conservatrice dans les tumeurs osseuses. La faillite de ces prothèses correspond à un échec mécanique ou à une infection qui nécéssite habituellement l'ablation de la prothèse.Le traitement de l'infection consiste en la revision chirurgicale de la prothèse avec ou sans mise en place temporaire d'un espaceur. Une couverture par lambeau (local ou libre) peut être nécessaire selon l'état des parties molles. Il semble que la mise en place de la prothèse au sein de parties molles bien vascularisées facilite l'éradication de l'infection. Présenta-tion d'une étude de 9 patients ayant une faillite de prothèse par infection et ayant besoin d'un lambeau de couverture. La revision a été faite en 2 temps, le second étant realisé si une série de prélévements dans l'espace péri-prothètique ne montraient plus de prolifération microbienne. Dans 5 cas la couverture était réalisée avec un lambeau local et dans 4 cas avec un lambeau libre. Les patients avec un lambeau musculo-cutané libre (grand dorsal) avaient un meilleur résultat. Les résultats précoces de cette petite série montrent que la reprise en 2 temps avec couverture prothètique par un lambeau musculaire donne un taux élevé de réussite dans la préservation des membres.

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“…It is well known that fasciocutaneous flaps and muscular tissue have proved to be of great value in reconstructing problem wounds due to their rich blood supply and superior resistance to infection (Arnold and Prunes-Carrillo 1981, Tobin 1985, Lesavoy et al 1989.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, several authors (Bengtson et al 1987, Greenberg et al 1989, Lesavoy et al 1989) have reported good results following coverage with muscle and musculocutaneous flaps. These achievements have prompted our present review of the long-term results of similar operative procedures performed at our department during the past 17 years.…”

Section: Methodsmentioning

confidence: 99%