1
|
Ríos Garrido X, De la Rosa A, Arzuza Ortega L, Vargas Lievano G, Molina Gándara J, Tellez Gamarra DA, Medina Monje C. Medial tab-type fasciocutaneous flap as an alternative for the management of soft tissue defects of the leg. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00084-5. [PMID: 38768748 DOI: 10.1016/j.recot.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/06/2024] [Accepted: 05/13/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Selecting the right technique for lower limb soft tissue reconstruction is a therapeutic challenge. Despite having several reconstruction options, it's important to choose a technique that is effective and with the least possible donor site morbidity. OBJECTIVE Demonstrate the therapeutic efficacy of the medial tab flap in soft tissue reconstruction on the leg, compared to conventional flaps. MATERIALS AND METHODS Cohort study matched by age. 64 patients with soft tissue defects were selected and according to the intervention divided in: group 1)medial tab flap, and group 2)conventional flaps (sural, soleus, gastrocnemius) followed up to one year postoperatively. OUTCOME VARIABLES surgical time in minutes, healing, healing time in days, complications. RESULTS The patients who underwent surgery with medial tab flap and with conventional flaps healed completely. The healing time was 16.2±11.2 days in the tab flap and 16.1±11.2 days in conventional flaps, no statistically significant differences were found between the groups (P=.89). The surgical time for tab flaps was 225.2±117.8minutes, and 191.3±117.2minutes for the comparison flaps (P=.65), there were no statistically significant differences. There were no complications in the medial tab flaps. CONCLUSION The findings suggest that the medial tab flap technique is as effective as the conventional flap technique, with complete flap survival and healing, and without any major complications in this studied group.
Collapse
Affiliation(s)
- X Ríos Garrido
- Ortopedista y Traumatóloga, Subespecialista en Microcirugía Reconstructiva, Barranquilla, Colombia
| | - A De la Rosa
- Departamento de Ortopedia y Traumatología, Clínica Bahía, Santa Marta, Colombia
| | | | - G Vargas Lievano
- Ortopedista y Traumatólogo, Cirujano de Pie y Tobillo, Barranquilla, Colombia
| | - J Molina Gándara
- Médico, Candidato a Magister en Epidemiología Clínica, Fundación Campbell, Barranquilla, Colombia
| | - D A Tellez Gamarra
- Residente de 4to año de Ortopedia, Universidad Libre, Barranquilla, Colombia.
| | - C Medina Monje
- Ortopedista y Traumatóloga, Magister en Educación, Barranquilla, Colombia
| |
Collapse
|
2
|
Brenneis M, Flevas DA, Gayle LB, Boettner F, Sculco PK, Westrich GH. Complex periprosthetic wound coverage in patients undergoing revision total knee arthroplasty: a single plastic surgeon study. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05240-6. [PMID: 38662001 DOI: 10.1007/s00402-024-05240-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 02/17/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Options for soft tissue coverage in revision total knee arthroplasty (rTKA) range from primary wound closure to complex muscle flap reconstructions. The purpose of this study was to investigate the institutional experience of wound coverage options for complex soft tissue defects in rTKA. MATERIALS AND METHODS 77 patients undergoing rTKA with complex wound closure by a single plastic surgeon were retrospectively reviewed. The average follow-up was 30.1 months. In 18 (23.4%) patients, an intraoperative decision for primary closure was made. Fifty-nine patients (76.6%) received either a local fasciocutaneous (N = 18), a medial gastrocnemius (N = 37), a free latissimus dorsi (N = 3) or a lateral gastrocnemius flap (N = 1). Revision-free survival and complication rates were assessed and risk factors were analyzed with Cox-regression analysis. RESULTS Medial gastrocnemius flaps had significant lower cumulative revision-free survival rates than local fasciocutaneous flaps (P = 0.021) and primary closures (P < 0.001) (42.5% vs. 71.5% vs. 100%,respectively). Comparing the most common complex closure procedures medial gastrocnemius flaps had the highest rate of prolonged wound healing (29.7%) and infection/reinfection (40.5%). Infection-associated flap procedures had significant lower cumulative revision-free survival rates (30.5%) than non-infection associated flap procedures (62.8%,P = 0.047). A history of more than two prior surgeries (HR = 6.11,P < 0.001) and an age ≥ 65 years (HR = 0.30,P = 0.018) significantly increased the risk of revision. CONCLUSIONS The results of this study indicate that primary closure -if possible- should be preferred to early proactive muscle flap coverage. Even in the hands of an experienced plastic surgeon muscle flaps have high revision and complication rates. The study highlights the need to clarify flap indications and to investigate alternative approaches.
Collapse
Affiliation(s)
- Marco Brenneis
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA.
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, Frankfurt / Main, Germany.
| | - Dimitrios A Flevas
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Lloyd B Gayle
- Division of Plastic Surgery, New York-Presbyterian Hospital, New York, NY, USA
| | - Friedrich Boettner
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Peter K Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Geoffrey H Westrich
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| |
Collapse
|
3
|
Chantelot C, Saab M, Martin T, Begue T, Ehlinger M, Flecher X. Revision total knee arthroplasty with periprosthetic distal femoral fracture. Orthop Traumatol Surg Res 2024:103856. [PMID: 38438108 DOI: 10.1016/j.otsr.2024.103856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/29/2024] [Accepted: 02/07/2024] [Indexed: 03/06/2024]
Abstract
Treatment strategies for periprosthetic distal femoral fracture depend on the type of fracture, level with respect to the prosthesis, and prosthesis fixation. The usual treatment is internal fixation by nail or locking plate. This can be more difficult when the fracture is close to the joint, is destabilizing the prosthesis or is associated with reduced bone stock, and implant exchange should be considered, depending on the patient's health status. The aim is to obtain the fastest possible recovery while limiting complications and minimizing surgery time for often frail and elderly patients. The present study details the implant revision technique in periprosthetic distal femoral fracture, which requires experience in traumatology and prosthetic revision and material adapted to the situation. LEVEL OF EVIDENCE: V, expert opinion.
Collapse
Affiliation(s)
- Christophe Chantelot
- Service de traumatologie, hôpital Salengro, CHU de Lille, avenue du Professeur Emile-Laine, 59000 Lille, France.
| | - Marc Saab
- Service de traumatologie, hôpital Salengro, CHU de Lille, avenue du Professeur Emile-Laine, 59000 Lille, France
| | - Théo Martin
- Service de traumatologie, hôpital Salengro, CHU de Lille, avenue du Professeur Emile-Laine, 59000 Lille, France
| | - Thierry Begue
- Service de traumatologie, hôpital Antoine-Béclère, 157, rue de la Porte de Trivaux, 92140 Clamart, France
| | - Matthieu Ehlinger
- Service de traumatologie, hôpital de Hautepierre, avenue Molière, 67200 Strasbourg, France
| | - Xavier Flecher
- Service de traumatologie, hôpital Nord, chemin des Bourrely, 13015 Marseille, France
| |
Collapse
|
4
|
Hecker A, Watzinger N, Pignet AL, Schellnegger M, Reinbacher P, Girsch W. Pedicled Rectus Femoris Flap for Restoration of Suprapatellar Quadriceps Tendon and Defect Coverage after Multiple Reconstruction Attempts-A Case Report and Literature Review. J Pers Med 2024; 14:136. [PMID: 38392570 PMCID: PMC10889967 DOI: 10.3390/jpm14020136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
There is no unified approach for restoring the suprapatellar quadriceps tendon and covering tissue defects simultaneously. In this case report, we present the pedicled myocutaneous rectus femoris flap as one effective approach in two cases with extensive loss or impairment of the suprapatellar muscle-tendon structures after trauma-related suprapatellar quadriceps tendon rupture and multiple reconstruction attempts. Additionally, we provide a literature review of the reconstructive use of the functional pedicled myocutaneous rectus femoris flap. METHODS Two male patients, 48 and 74 years old, with extensive loss or impairment of the suprapatellar muscle-tendon structures due to multiple reconstruction attempts, underwent restoration of the knee extension with a pedicled myocutaneous rectus femoris flap. RESULTS Three months after reconstruction, both patients were able to walk freely, unaided. After a six-month follow-up, the free passive mobility of the knee joint was restored, and the active extension of the knee joint was possible in both patients. CONCLUSION The authors conclude that the pedicled rectus femoris flap is a reliable method for the restoration of knee extension, with excellent functional results in cases of suprapatellar tendon lesions. Further to the functional restoration, this technique has the additional advantage of simultaneously achieving coverage of soft-tissue defects, while a direct closure of the donor site is possible. Elderly patients and patients with relevant comorbidities or multiple revisions may especially benefit from this technique.
Collapse
Affiliation(s)
- Andrzej Hecker
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/4, 8036 Graz, Austria
- COREMED-Center for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, Neue Stiftingtalstraße 2, 8010 Graz, Austria
| | - Nikolaus Watzinger
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/4, 8036 Graz, Austria
| | - Anna-Lisa Pignet
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/4, 8036 Graz, Austria
- COREMED-Center for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, Neue Stiftingtalstraße 2, 8010 Graz, Austria
| | - Marlies Schellnegger
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/4, 8036 Graz, Austria
| | - Patrick Reinbacher
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Werner Girsch
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/4, 8036 Graz, Austria
| |
Collapse
|
5
|
Kim BI, Wixted CM, Schwartz AM, Jiranek WA, Ryan SP, Seyler TM. Risk factors for failure after rotational muscle flap coverage for prosthetic knee infections. J Orthop Surg (Hong Kong) 2024; 32:10225536241230349. [PMID: 38279963 DOI: 10.1177/10225536241230349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2024] Open
Abstract
INTRODUCTION Soft tissue defects are a devastating complication of prosthetic joint infections (PJI) after total knee arthroplasty (TKA). Rotational flaps are commonly utilized to address these defects with variable reports of success. This study aimed to identify predictors of poor outcomes in rotational muscle flap placement after prosthetic knee infections. The authors hypothesized that outcomes may vary based on infecting pathogen and treatment characteristics. METHODS 44 cases of rotational muscle flaps for prosthetic knee infection were retrospectively evaluated at a tertiary referral hospital from 2007 to 2020. Muscle flap types included 39 medial and four lateral gastrocnemius, and one anterior tibialis. Minimum follow-up was 1 year (median: 3.4 years). Primary outcome was flap-related complications. Secondary outcomes included recurrent infection requiring additional surgery, final joint outcomes, and mortality. RESULTS One-year complication-free flap survivorship was 83.9%, recurrent infection-free survivorship was 65.7%, and amputation-free survivorship was 79%. Multivariable cox regression revealed that rheumatoid arthritis diagnosis (HR: 3.4; p = .028) and methicillin-resistant Staphylococcus aureus-positive culture (HR: 4.0; p = .040) had increased risk, while Coagulase-negative Staphylococcus infections had reduced risk for recurrent or persistent infection (HR: 0.2; p = .023). Final joint outcome was retained TKA implant in 18 (40.9%), amputation in 15 (34.1%) patients, and definitive treatment with articulating spacer in 10 (22.7%). 5-years survivorship from death was 71.4%. CONCLUSION Rotational muscle flaps for soft tissue coverage of the knee are often performed in limb salvage situations with poor survivorship from flap complications, reinfections, and amputation. When considering surgical options for limb salvage, patients should be counseled on these risks.
Collapse
Affiliation(s)
- Billy I Kim
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Colleen M Wixted
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | | | | | - Sean P Ryan
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | | |
Collapse
|
6
|
Wiberg R, Mukka C, Backman O, Stålhult G, Edmundsson D, Mukka S. Outcome following soft tissue coverage with a medial gastrocnemius flap of an exposed or infected total knee arthroplasty. Scand J Surg 2023; 112:173-179. [PMID: 37264639 DOI: 10.1177/14574969231175562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Soft tissue defects or periprosthetic infections after total knee arthroplasty (TKA) are severe complications that may lead to loss of the arthroplasty or the limb. Reconstructions with medial gastrocnemius flaps (MGF) are occasionally used to provide soft tissue coverage around the knee. AIMS The study aimed to establish the rate of implant survivorship after MGF reconstruction for soft tissue coverage in the treatment of exposed or infected TKA and to establish functional outcome. METHODS A retrospective analysis was performed on all patients who received soft tissue coverage with an MGF of an exposed or infected TKA between 2000 and 2017 at the Department of Hand and Plastic Surgery at Umeå University Hospital. The outcomes were implant survivorship and patient-reported outcome measures (PROMs) using the five-level EQ-5D version and The Knee Injury and Osteoarthritis Outcome Score. RESULTS Forty-seven patients (mean age = 67 years, 30 women) were included. The mean time between flap coverage and follow-up was 6.7 (±3.4) years. Implant survivorship was observed in 28 of 47 (59.6%) patients at follow-up. Flap failure was rare, with only 3 of 47 (6.4%) cases. Of the 20 patients who answered the PROMs, 10 of 20 experienced moderate to severe pain or discomfort. CONCLUSIONS Due to unfavorable underlying conditions, MGF reconstruction after TKA is often associated with a compromised functional outcome. Because donor site morbidity is limited and flap failure is unusual, the procedure can be considered prophylactically in a small subset of patients with risk factors to prevent soft tissue defects and periprosthetic joint infection.
Collapse
Affiliation(s)
- Rebecca Wiberg
- Hand and Plastic surgery Department of Surgical and Perioperative SciencesUmeå University Umeå SE-901 87 Sweden
| | - Camilla Mukka
- Hand and Plastic Surgery, Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Olof Backman
- Hand and Plastic Surgery, Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Göran Stålhult
- Hand and Plastic Surgery, Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - David Edmundsson
- Orthopedics, Department of Surgical and Perioperative Sciences, Umeå University, Sweden
| | - Sebastian Mukka
- Orthopedics, Department of Surgical and Perioperative Sciences, Umeå University, Sweden
| |
Collapse
|
7
|
Kahramangil B, Pires G, Montorfano L, Riesgo AM, Ghaznavi AM. The Utility of Flap Coverage for Limb Salvage in Patients With Severe Prosthetic Joint Infections of the Knee Requiring Implant Exchange. Ann Plast Surg 2023; 91:129-136. [PMID: 37450871 DOI: 10.1097/sap.0000000000003600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND Prosthetic joint infection (PJI) is a challenging complication of knee arthroplasty, which can require amputation in severe cases. This study analyzes the utility of flap reconstruction in PJIs requiring hardware removal and extensive soft tissue debridement. METHODS This was a retrospective analysis of patients who were treated according to a multistage extremity salvage protocol between 2018 and 2022. The protocol involved at least 3 planned surgeries including (1) hardware removal with antibiotic spacer placement and soft tissue debridement, (2) spacer exchange with flap coverage, and (3) hardware reimplantation with simultaneous or delayed extensor mechanism reconstruction. All patients had large periprosthetic tissue defects that would necessitate an amputation if not reconstructed. Primary outcomes were extremity salvage and successful defect coverage. RESULTS Fifty-two patients (25 female) underwent 62 reconstructions (52 primary, 10 salvage). Flap techniques included pedicled muscular (n = 32), fasciocutaneous (n = 4), combined muscular and fasciocutaneous (n = 2), and free flaps (n = 24). Overall rate of successful defect coverage was 95% (98% in primary and 80% in salvage reconstructions). At a median follow-up of 11 months, 41 patients completed the treatment protocol with a 68% (n = 28) extremity salvage rate (reimplantation arthroplasty, n = 15; permanent knee fusion, n = 13). On the multivariate model including demographic factors, defect size, and flap type, no single factor independently predicted limb salvage. CONCLUSIONS Alongside intensive orthopedic surgical treatment, flap coverage may aid in extremity salvage in severe knee PJIs by reestablishing healthy soft tissue coverage and allowing reimplantation arthroplasty. We recommend a multispecialty approach including plastic surgeons for this challenging condition.
Collapse
Affiliation(s)
- Bora Kahramangil
- From the Department of General Surgery, Cleveland Clinic Florida, Weston
| | - Giovanna Pires
- Florida Atlantic University Schmidt College of Medicine, Boca Raton, FL
| | - Lisandro Montorfano
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | | |
Collapse
|
8
|
Cepas A, Tammela I, Nieminen J, Laitinen M, Karppelin M, Kaartinen I, Kiiski J. Surgical and patient-reported outcomes after total knee arthroplasty requiring soft-tissue flap reconstruction - 12-year experience from high volume arthroplasty hospital. J Plast Reconstr Aesthet Surg 2022; 75:3732-3742. [DOI: 10.1016/j.bjps.2022.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 03/06/2022] [Accepted: 06/05/2022] [Indexed: 10/18/2022]
|
9
|
CAI YC, ZHANG GY, LIAN J, SHI WJ, CAI YQ, FENG QY, ZHU L. Pre-expanded Muscle-Sparing Latissimus Dorsi Free Flap: An Ideal Option for the Reconstruction of Extensive Anterior Knee Contractures. J Plast Reconstr Aesthet Surg 2022; 75:3743-3750. [DOI: 10.1016/j.bjps.2022.06.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 05/19/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022]
|
10
|
The Proximal Placement of the Knee Joint in the 1-Stage Treatment of Infected Knee Revisions With Large Anterior Soft Tissue Defects. Tech Orthop 2021. [DOI: 10.1097/bto.0000000000000553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
11
|
Theil C, Stock ME, Gosheger G, Moellenbeck B, Schwarze J, Schmidt-Braekling T. Gastrocnemius Muscle Flaps for Soft Tissue Coverage in Periprosthetic Knee Joint Infection. J Arthroplasty 2020; 35:3730-3736. [PMID: 32694027 DOI: 10.1016/j.arth.2020.06.074] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/17/2020] [Accepted: 06/25/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Soft tissue deficiency in total knee arthroplasty infection is a potentially devastating complication. Gastrocnemius muscle flaps can be used to address this problem. We aim at reporting survival rates of these reconstructions and identify risk factors for failure. METHODS A retrospective evaluation of all flaps performed at a single center between 2006 and 2019 was performed. Clinical and microbiological results were assessed in 43 cases after a median follow-up period of 53 months (25%-75% interquartile range 18-79). Function was assessed using the Oxford Knee Score. We analyzed the infection-free survival and identified risk factors using survival comparison and (non-)parametric testing. RESULTS Infection-free survival was 71% at 2 years and 63% at 5 years. The rate of subsequent amputation was 16% with a mortality rate of 26% during follow-up. Four patients did not undergo reimplantation and 11 patients received an arthrodesis implant. There were no failures of the flap itself. The Charlson Comorbidity index was the only relevant risk factor for reinfection. Coagulase-negative staphylococci were most common organisms identified. Postoperative function was limited with a mean Oxford Knee Score of 20. CONCLUSION Gastrocnemius flap coverage is a valid option for soft tissue reconstruction in periprosthetic infections to retain a functioning limb despite a high complication rate and the risk of subsequent amputation.
Collapse
Affiliation(s)
- Christoph Theil
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Maren E Stock
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Georg Gosheger
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Burkhard Moellenbeck
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Jan Schwarze
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Tom Schmidt-Braekling
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| |
Collapse
|
12
|
Soft tissue coverage options around the knee. ANN CHIR PLAST ESTH 2020; 65:517-523. [PMID: 32718770 DOI: 10.1016/j.anplas.2020.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 07/01/2020] [Indexed: 11/21/2022]
Abstract
Defects around the knee exhibit various etiologies and pose challenges to both orthopedists and plastic surgeons. While a number of reconstructive coverage options are available, flaps are almost always required for complex defects. Many local flaps are easily placed, including muscle and perforator flaps sourced from the thigh to the leg. As the recipient vessels lie deep, free tissue transfers are challenging. Good postoperative management and efficient collaboration between orthopedic and reconstructive surgeons are the keys to successful knee reconstruction, restoring an esthetic contour and preserving joint function.
Collapse
|
13
|
Early Plastic Surgery Involvement Improves Outcomes in Total Joint Arthroplasty Patients With Soft Tissue Complications. Tech Orthop 2020. [DOI: 10.1097/bto.0000000000000476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
Kankala RK, Zhao J, Liu CG, Song XJ, Yang DY, Zhu K, Wang SB, Zhang YS, Chen AZ. Highly Porous Microcarriers for Minimally Invasive In Situ Skeletal Muscle Cell Delivery. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2019; 15:e1901397. [PMID: 31066236 PMCID: PMC6750270 DOI: 10.1002/smll.201901397] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 04/12/2019] [Indexed: 05/19/2023]
Abstract
Microscale cell carriers have recently garnered enormous interest in repairing tissue defects by avoiding substantial open surgeries using implants for tissue regeneration. In this study, the highly open porous microspheres (HOPMs) are fabricated using a microfluidic technique for harboring proliferating skeletal myoblasts and evaluating their feasibility toward cell delivery application in situ. These biocompatible HOPMs with particle sizes of 280-370 µm possess open pores of 10-80 µm and interconnected paths. Such structure of the HOPMs conveniently provide a favorable microenvironment, where the cells are closely arranged in elongated shapes with the deposited extracellular matrix, facilitating cell adhesion and proliferation, as well as augmented myogenic differentiation. Furthermore, in vivo results in mice confirm improved cell retention and vascularization, as well as partial myoblast differentiation. These modular cell-laden microcarriers potentially allow for in situ tissue construction after minimally invasive delivery providing a convenient means for regeneration medicine.
Collapse
Affiliation(s)
- Ranjith Kumar Kankala
- Institute of Biomaterials and Tissue Engineering, Huaqiao University, Xiamen, 361021, P. R. China
- Fujian Provincial Key Laboratory of Biochemical Technology, Huaqiao University, Xiamen, 361021, P. R. China
| | - Jia Zhao
- Institute of Biomaterials and Tissue Engineering, Huaqiao University, Xiamen, 361021, P. R. China
| | - Chen-Guang Liu
- Institute of Biomaterials and Tissue Engineering, Huaqiao University, Xiamen, 361021, P. R. China
| | - Xiao-Jie Song
- Institute of Biomaterials and Tissue Engineering, Huaqiao University, Xiamen, 361021, P. R. China
| | - Da-Yun Yang
- Fujian Key Laboratory for Translational Research in Cancer and Neurodegenerative Diseases, Institute for Translational Medicine, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian, 350108, P. R. China
| | - Kai Zhu
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China
| | - Shi-Bin Wang
- Institute of Biomaterials and Tissue Engineering, Huaqiao University, Xiamen, 361021, P. R. China
- Fujian Provincial Key Laboratory of Biochemical Technology, Huaqiao University, Xiamen, 361021, P. R. China
| | - Yu Shrike Zhang
- Division of Engineering in Medicine, Brigham and Women's Hospital, Department of Medicine, Harvard Medical School, Cambridge, MA, 02139, USA
| | - Ai-Zheng Chen
- Institute of Biomaterials and Tissue Engineering, Huaqiao University, Xiamen, 361021, P. R. China
- Fujian Provincial Key Laboratory of Biochemical Technology, Huaqiao University, Xiamen, 361021, P. R. China
| |
Collapse
|
15
|
Reconstruction of Soft Tissue Defects Around the Knee With Pedicled Perforator Flaps. Ann Plast Surg 2018; 81:462-467. [DOI: 10.1097/sap.0000000000001544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
16
|
Warren SI, Murtaugh TS, Lakra A, Reda LA, Shah RP, Geller JA, Cooper HJ. Treatment of Periprosthetic Knee Infection With Concurrent Rotational Muscle Flap Coverage Is Associated With High Failure Rates. J Arthroplasty 2018; 33:3263-3267. [PMID: 29891399 DOI: 10.1016/j.arth.2018.05.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/13/2018] [Accepted: 05/14/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Soft-tissue deficiency is a potentially devastating complication of the infected total knee arthroplasty (TKA). Rotational muscle flaps are commonly used to address these defects. However, reported success rates vary widely. METHODS We reviewed 26 consecutive patients who underwent rotational muscle flap surgery for full-thickness anterior soft-tissue defect during treatment of an infected TKA. Twenty-four cases used a medial gastrocnemius rotational flap, 1 used a lateral gastrocnemius flap, and 1 used a rectus femoris-vastus intermedius flap. Implant survival, recurrence of infection, and limb survival were reported. Patient and procedural characteristics were tested for association with failure using χ2 and Student t-test. Kaplan-Meier analysis was used to estimate the failure-free survival function. RESULTS Mean follow-up time was 3.3 years. Eighteen of 26 patients (69.2%) experienced recurrent infection requiring an average of 5.3 additional operations (range, 1-20). Five (19.2%) required arthrodesis while 6 (23.1%) eventually underwent above-the-knee amputation. Two patients (7.7%) died due to complications of revision surgery or persistent infection. Eleven patients (42.3%) were infection free with a retained prosthesis after treatment at a mean follow-up of 5.3 years (range, 0.7-18.0 years). CONCLUSION Rotational muscle flap coverage of soft-tissue defects in the setting of the infected TKA remains a viable salvage option. However, despite adequate tissue coverage, many patients experience recurrent infection requiring additional surgical treatment. Patients and surgeons should be aware of the potential high failure rates observed when treating these complex problems.
Collapse
Affiliation(s)
- Shay I Warren
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York
| | - Taylor S Murtaugh
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York
| | - Akshay Lakra
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York
| | - Luke A Reda
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York
| | - Roshan P Shah
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York
| | - Jeffrey A Geller
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York
| | - H John Cooper
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York
| |
Collapse
|
17
|
Soft-Tissue Reconstruction of the Complicated Knee Arthroplasty: Principles and Predictors of Salvage. Plast Reconstr Surg 2018; 141:1040-1048. [PMID: 29596192 DOI: 10.1097/prs.0000000000004255] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Total knee arthroplasty is a common orthopedic procedure in the United States and complications can be devastating. Soft-tissue compromise or joint infection may cause failure of prosthesis requiring knee fusion or amputation. The role of a plastic surgeon in total knee arthroplasty is critical for cases requiring optimization of the soft-tissue envelope. The purpose of this study was to elucidate factors associated with total knee arthroplasty salvage following complications and clarify principles of reconstruction to optimize outcomes. METHODS A retrospective review of patients requiring soft-tissue reconstruction performed by the senior author after total knee arthroplasty over 8 years was completed. Logistic regression and Fisher's exact tests determined factors associated with the primary outcome, prosthesis salvage versus knee fusion or amputation. RESULTS Seventy-three knees in 71 patients required soft-tissue reconstruction (mean follow-up, 1.8 years), with a salvage rate of 61.1 percent, mostly using medial gastrocnemius flaps. Patients referred to our institution with complicated periprosthetic wounds were significantly more likely to lose their knee prosthesis than patients treated only within our system. Patients with multiple prior knee operations before definitive soft-tissue reconstruction had significantly decreased rates of prosthesis salvage and an increased risk of amputation. Knee salvage significantly decreased with positive joint cultures (Gram-negative greater than Gram-positive organisms) and particularly at the time of definitive reconstruction, which also trended toward an increased risk of amputation. CONCLUSIONS In revision total knee arthroplasty, prompt soft-tissue reconstruction improves the likelihood of success, and protracted surgical courses and contamination increase failure and amputations. The authors show a benefit to involving plastic surgeons early in the course of total knee arthroplasty complications to optimize genicular soft tissues. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
Collapse
|
18
|
|
19
|
Parra L, Andrés J, Robustillo M, García C, Iglesias I, Díaz A. Ipsilateral Arteriovenous Loop and Latissimus Dorsi Free Flap for Knee Reconstruction in an Elderly Patient: A Case Report. World J Plast Surg 2018; 7:377-381. [PMID: 30560081 PMCID: PMC6290313 DOI: 10.29252/wjps.7.3.377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Herein, we report an unusual indication of an arteriovenous (AV) loop with a latissimus dorsi free flap after wound-edge necrosis in an 81 year old patient. The patient underwent multiple revision procedures after total knee arthroplasty and total hip arthroplasty. After a dramatic reduction of femoral bone, a total femoral replacement was performed. The lateral knee incision wound was broke down and the hardware became exposed. Local flaps were not available and a free flap with an ipsilateral AV loop from the great saphenous vein was used to cover the large defect. The functional status of the hip and knee joints was good after 6 months, and enough the patient was able to ambulate without any assistance. The patient did not show any signs of infection.
Collapse
Affiliation(s)
- Luis Parra
- Department of Plastic and Reconstructive Surgery, 12 de Octubre University Hospital, Madrid, Spain
| | - Juan Andrés
- Department of Plastic and Reconstructive Surgery, 12 de Octubre University Hospital, Madrid, Spain
| | - Manuel Robustillo
- Department of Plastic and Reconstructive Surgery, 12 de Octubre University Hospital, Madrid, Spain
| | - Carlos García
- Department of Plastic and Reconstructive Surgery, 12 de Octubre University Hospital, Madrid, Spain
| | - Israel Iglesias
- Department of Plastic and Reconstructive Surgery, 12 de Octubre University Hospital, Madrid, Spain
| | - Antonio Díaz
- Department of Plastic and Reconstructive Surgery, 12 de Octubre University Hospital, Madrid, Spain
| |
Collapse
|
20
|
Hallock GG. Soft Tissue Coverage After Revisional Foot and Ankle Surgery. Clin Podiatr Med Surg 2017; 34:389-398. [PMID: 28576197 DOI: 10.1016/j.cpm.2017.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Unlike the traumatic "mangled" foot and ankle in which amputation could be an acceptable if not preferred option, revisional foot and ankle surgery starts with a viable foot that is then injured by the surgeon hopefully to benefit the patient. Any untoward sequela, such as inadequate wound healing, instead always requires consideration of limb salvage. Unfortunately, this may not be so simple. A proactive approach to solve this problem in a timely fashion is important. The goal must always be to get a healed wound so the final result improves the ability for independent ambulation by the patient.
Collapse
Affiliation(s)
- Geoffrey G Hallock
- Division of Plastic Surgery, Sacred Heart Hospital, The Lehigh Valley Hospital, 1230 South Cedar Crest Boulevard, Suite 306, Allentown, PA 18103, USA.
| |
Collapse
|
21
|
Chiang IH, Wu CC, Chen SG, Wang CH. Pedicled medial sural perforator flap for the reconstruction of knee defects. Int Wound J 2016; 14:673-677. [PMID: 27696708 DOI: 10.1111/iwj.12668] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/10/2016] [Accepted: 08/21/2016] [Indexed: 11/30/2022] Open
Abstract
Soft tissue defects exposing the patellar tendon or bone are common in patients who have experienced trauma or implant infection. The purpose of this article is to present our experience of six patients who underwent reconstruction of soft tissue defects of the knee using a pedicled medial sural perforator flap. Between November 2013 and November 2015, six patients who presented with a soft tissue defect overlying the knee were admitted to our hospital. After adequate debridement or wide excision of the tumour, these patients underwent pedicled medial sural perforator flap placement to resurface the complex soft tissue defects and to provide a gliding surface for the exposed patellar tendon. The patients' age, comorbidity, aetiology, defect size and location, flap size, perforator numbers and lengths, outcome and follow-up period were reviewed. The six medial sural perforator flaps survived completely, and the wounds healed satisfactorily over a mean follow-up of 21·5 months (range, 6-51 months). Donor sites were closed primarily or covered with a split-thickness skin graft. The medial sural perforator flap is a reliable flap for coverage of defects overlying the knee. The thin and pliable flap, long pedicle length and less donor site mobility benefit patients. Thus, the medial sural perforator flap may be a valuable alternative for defect reconstructions overlying the knee, which produces satisfactory results both functionally and cosmetically.
Collapse
Affiliation(s)
- I-Han Chiang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chia-Chun Wu
- Department of Orthopaedic Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Shyi-Gen Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chih-Hsin Wang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| |
Collapse
|