Reconstruction of soft tissue defects following total knee arthroplasty

What Factors Influence the Success of Medial Gastrocnemius Flaps in the Treatment of Infected TKAs?

“…Patients in our study generally had multiple prior knee procedures (four on average), which may have contributed to poor outcomes overall secondary to decreased blood supply and residual scarring [13], but we were unable to isolate this variable as an independent risk factor for treatment failure. We similarly were unable to substantiate other potential risk factors for failure of salvage muscle flaps, including sex, age, BMI, infecting organism, type of antibiotic spacer, or individual comorbidities (tobacco use [20,31], reflex sympathetic dystrophy syndrome [19], diabetes [19,20], chronic renal failure [20], peripheral vascular disease [20], and steroid use [20]). Despite these no-difference findings, the study may have been underpowered and the optimization of modifiable variables is advised perioperatively, when possible.…”

“…Although some authors [8,19,20,31] have proposed poor prognostic factors based on smaller series, our study is the first, to our knowledge, to statistically evaluate factors associated with flap failure in this setting. There was a trend toward failure when flap coverage was performed at the same time as antibiotic spacer placement but this did not reach statistical significance.…”

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

“…As roughly 30% of patients who present with superficial postoperative wound infections ultimately seed their hardware, early and aggressive management of infection and/or wound breakdown is imperative to ensure stable soft tissue coverage of the prosthesis and prevent further complications [35]. When primary closure is difficult or impossible, more expansive wounds generally require either local fasciocutaneous flaps or pedicled muscle flaps to obtain adequate coverage [11142845464748]. No consensus has been reached on the optimal coverage of these defects, and the results from our review of the current literature show no significant differences between the coverage options in terms of rates of device/limb salvage, complications, persistent joint infection, reoperation, arthrodesis, or amputation.…”

Emprego do músculo gastrocnêmio no tratamento das lesões infectadas do joelho

“…After achieving wounds with favorable appearance on soft parts and bone tissue, coverage becomes necessary. Several options are available: simple dressings 6 , negativepressure dressings 22 , fasciocutaneous flaps 23 , pedicled muscle flaps 11,24 or free muscle flaps 25 , with or without knee arthrodesis 26 , up to amputations. 27 There is no algorithm able to clearly and safely outline one of these alternatives, once each case has its own peculiarities.…”