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Case Reports
. 2022 Feb;12(2):38-41.
doi: 10.13107/jocr.2022.v12.i02.2656.

Surgical Treatment of Stage Four Knee Pressure Injury with Pedicled Fasciocutaneous Flap in Patient Affected by Spina Bifida - Case Report

Enrico M Zingarelli  1 , Luca Perrero  2 , Marco Ghiglione  1 , Renzo Panizza  1
Affiliations
Case Reports

Surgical Treatment of Stage Four Knee Pressure Injury with Pedicled Fasciocutaneous Flap in Patient Affected by Spina Bifida - Case Report

Enrico M Zingarelli et al. J Orthop Case Rep. 2022 Feb.

Abstract

Introduction: Patients affected by spina bifida (SB) can present varying degrees of paralysis, limited mobility, impaired sensation, orthopedic problems and bowel, bladder, and renal impairments. Skin wounds are reported as one of the primary diagnosis associated with hospitalizations in SB affected patients. In young patients, pressure injuries can occur more frequently at the lower limb. A multidisciplinary approach and a proper surgical technique are mandatory to obtain favorable long-term outcomes, in terms of adequate coverage and risk of recurrence.

Case presentation: A Caucasian male 21-year-old wheelchair-bound patient with history of SB was admitted to our department with stage four pressure injury on the medial aspect of knee joint and osteomyelitis. After antibiotic therapy wound preparation and debridement, we covered the pressure sore with a pedicled fasciocutaneous flap harvested from the medial compartment of the thigh. In the distal part, we splitted the fascia from the flap and used it to reconstruct the exposed knee joint. We did not report any complications and no recurrence was observed at 1-year follow-up examination.

Conclusion: In this reported case, the multidisciplinary approach and the surgical technique allowed us to cover the soft-tissue defect around knee joint, reducing morbidity, surgical time, and cost with good long-term outcomes.

Keywords: Spina bifida; fasciocutaneous flap; pressure injuries.

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Conflict of interest statement

Conflict of Interest: Nil

Figures

Figure 1
Figure 1
Wound after 2 weeks of hospitalization
Figure 2
Figure 2
Wound after 15 days of NPWT.
Figure 3
Figure 3
Pre-operative planning.
Figure 4
Figure 4
Radical debridement of the ulcer was performed using methylene blue staining.
Figure 5
Figure 5
Wound bed after debridement.
Figure 6
Figure 6
Flap elevation
Figure 7
Figure 7
Coverage of the knee joint with a fascial flap.
Figure 8
Figure 8
Flap at the end of the surgical procedure
Figure 9
Figure 9
The patient 1 month after surgery.
Figure 10
Figure 10
One year follow-up.
See this image and copyright information in PMC

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