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. 2014 Jul;38(7):1387-92.
doi: 10.1007/s00264-014-2316-z. Epub 2014 Mar 25.

Flaps for closure of soft tissue defects in infected revision knee arthroplasty

Arnold J Suda  1 , Angela Cieslik, Paul A Grützner, Matthias Münzberg, Volkmar Heppert
Affiliations

Flaps for closure of soft tissue defects in infected revision knee arthroplasty

Arnold J Suda et al. Int Orthop. 2014 Jul.

Abstract

Purpose: Total knee arthroplasty revision has wound healing deficits of up to 20 %. Defects in the knee region of multimorbid patients are hard to treat as complete explantation and revision arthroplasty is often too burdensome for them. In this study, we present our results with flaps for the treatment of defects after knee replacement, arthrodesis or osteosynthesis.

Methods: Twenty-five patients (26 knees) with defects in the knee region were treated with flaps. Mean follow-up was 37 months (13-61) and the patients had a mean age of 72 years (49-85). A total of 39 flaps were performed (27 muscle flaps, seven fascio-cutaneous flaps and five free flaps).

Results: Patients with more than three comorbidities showed higher risk of complications after surgery. Fifteen patients showed no infection at last follow up. Five patients received an arthrodesis of the knee, two showed persistent infection of the implant with fistula, and three were amputated above the knee.

Conclusions: Amputation could be avoided in 22 cases (85 %). The gastrocnemius muscle flap showed good results in the treatment of defects after arthroplasty or arthrodesis of the knee in multimorbid patients. This procedure can be used if further revision surgery is not indicated.

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Figures

Fig. 1
Fig. 1
"Reflexion-test positive" soft tissue defect after total knee replacement (TKR)
Fig. 2
Fig. 2
Minor complications occurred and treatment
Fig. 3
Fig. 3
Complications after flap surgery related to the main comorbidities occurred in the collective
Fig. 4
Fig. 4
Results 12 days after pediculated lateral gastrocnemius flap
See this image and copyright information in PMC

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