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

Tetreault, Matthew W.; Valle, Craig J. Della; Bohl, Daniel D.; Lodha, Suresh K.; Biswas, Dhrubes; Wysocki, Robert

doi:10.1007/s11999-015-4624-z

Cited by 31 publications

(39 citation statements)

References 32 publications

(54 reference statements)

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“…The gastrocnemius flap has historically been an excellent option for coverage of the knee particularly with periprosthetic infection, and this was the primary indication in our cohort. 28 – 30 As many as 52% of patients who undergo a gastrocnemius flap for coverage of an infected total knee arthroplasty (TKA) experience reinfection and require reoperation. Given the strong association between the gastrocnemius muscle flap, positive PDC, and wound breakdown, we decided to reanalyze our data with this subset of patients excluded.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Positive Postdebridement Cultures on Local Muscle Flap Reconstruction of the Lower Extremity

Kanuri

O’Kelly

Shuck

et al. 2018

Plastic and Reconstructive Surgery - Global Open

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Background:Local muscle flaps are a reconstructive option for wound coverage in the distal lower extremity, particularly in high-risk patients who are poor candidates for free tissue transfer. At our institution, chronic and infected wounds are managed with serial debridement before definitive reconstruction. There is a paucity of data on optimal timing for reconstruction in this patient population. This study investigates the relationship of positive postdebridement cultures (PDC) and wound closure rates at 90 days.Methods:A retrospective review of patients undergoing local muscle flap coverage of chronic distal lower extremity wounds between 2006 and 2012 was performed. All patients were managed with serial debridement until negative PDC were obtained. In some cases, PDC remained positive or exhibit delayed culture growth in the day(s) following closure. Data recorded include demographics, flap type/location, culture data, and wound closure at 90-day follow-up.Results:Of 76 patients, 60 met inclusion criteria with minimum 90-day follow-up. Despite 100% flap survival, 17 patients (28.3%) had failure of wound closure at 90 days and 22 patients (36%) had positive PDC. Multivariate analysis identified positive PDC (odds ratio, 29.6; 95% CI, 3.6–246.4; P = 0.002) and smoking (odds ratio, 8.9; 95% CI, 1.4–57.6; P = 0.02) as independent predictors of nonclosure at 90 days.Conclusions:In this series of local muscle flap coverage of distal lower extremity wounds, positive PDC were a strong independent predictor of failure of wound closure at 90 days. This study demonstrates the importance of serial debridement to negative cultures before definitive coverage in this patient population.

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Section: Discussionmentioning

confidence: 99%

The Effect of Positive Postdebridement Cultures on Local Muscle Flap Reconstruction of the Lower Extremity

Kanuri

O’Kelly

Shuck

et al. 2018

Plastic and Reconstructive Surgery - Global Open

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“…The medial head of gastrocnemius muscle can be used as a flap in various types: island myocutaneous arterial flap, muscle flap with skin graft, distaly based flap, bipedicular flap, cross-leg flap and a free flap (14)(15)(16)(17).…”

Section: Discussionmentioning

confidence: 99%

Island myocutaneous medial gastrocnemius flap in the reconstruction of knee and proximal lower leg defects

Vulović¹

2018

Medicinski časopis

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“…We initially performed soft tissue reconstruction with a combined gastrocnemius flap and popliteo-posterior thigh fasciocutaneous island flap to treat the very wide burn scar ( Fig. 3) [9][10][11][12][13]. Eight weeks after reconstructive surgery of the soft tissue, we performed knee joint-bridging circular hexapod external fixation of the femur and the tibia [14][15][16].…”

Section: Case Presentationmentioning

confidence: 99%

Effectiveness of circular hexapod external fixation with soft tissue reconstruction in treating severe knee dislocation due to burn scarring: a case report

Nozaka

Miyakoshi

Saito

et al. 2020

BMC Musculoskelet Disord

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Background Severe varus deformity and soft tissue injury caused by a burn around a complex knee dislocation is a rare injury. Soft tissue reconstruction and deformity correction with circular hexapod external fixation of the knee and hinged total knee arthroplasty (TKA) are challenging and can lead to major complications if not performed appropriately. We present a case in which a combination of soft tissue reconstruction, circular hexapod external fixation, and TKA was used treat severe knee dislocation due to burn scarring. Case presentation We report the case of a 58-year-old woman who presented for knee surgery with soft tissue reconstruction, deformity correction with circular hexapod external fixation, and hinged TKA for a severe complex deformity and soft tissue injury caused by a burn injury at 6 months of age. The left leg was shorter by 35 mm in terms of functional leg length discrepancy. She walked with a limp, with a marked varus deformity of the left knee during the stance phase of walking. After a 3-stage repair, the patient was able to walk without assistance, confirming improvement of mobility. Conclusion The treatment method was an effective use of a combination of soft tissue reconstruction, circular hexapod external fixation, and rehearsal surgery using a 3D printed bone model of the modular rotating hinge component of TKA, which was successfully used to treat a severe knee dislocation due to burn scarring. This staged surgery maintained the leg length and ultimately achieved a satisfactory alignment.

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

Cited by 31 publications

References 32 publications

The Effect of Positive Postdebridement Cultures on Local Muscle Flap Reconstruction of the Lower Extremity

The Effect of Positive Postdebridement Cultures on Local Muscle Flap Reconstruction of the Lower Extremity

Island myocutaneous medial gastrocnemius flap in the reconstruction of knee and proximal lower leg defects

Effectiveness of circular hexapod external fixation with soft tissue reconstruction in treating severe knee dislocation due to burn scarring: a case report

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