Ries Michael D, Bozic Kevin J
Department of Orthopaedic Surgery, University of California, San Francisco, CA 94143-0728, USA.
Clin Orthop Relat Res. 2006 May;446:186-92. doi: 10.1097/01.blo.0000218723.21720.51.
Skin necrosis after total knee arthroplasty is a rare complication that can rapidly lead to deep infection of the prosthetic components. The medial gastrocnemius transposition flap usually provides adequate soft tissue coverage to salvage the total knee arthroplasty. However, variations in defect location and excursion of the muscle flap can affect results. Twelve patients were treated with a medial gastrocnemius transposition flap after total knee arthroplasty. The skin defect that required flap coverage was located over the tibial tubercle or patellar tendon in eight patients (Group 1). The defect extended proximally to the patella or quadriceps tendon in four patients (Group 2). A functioning total knee arthroplasty was salvaged in 11 patients (92%). The medial gastrocnemius flap healed primarily in all patients in Group 1. Three patients in Group 2 required additional fasciocutaneous, lateral gastrocnemius, or free flap coverage, and one patient underwent above knee amputation. The medial gastrocnemius flap is most effective for coverage of distal defects over the tibial tubercle or patellar tendon. Defects that extend more proximally over the patella or quadriceps tendon are more likely to require additional procedures to achieve adequate soft tissue coverage.
Therapeutic study, level IV (case series). See Author Guidelines for a complete description of levels of evidence.
全膝关节置换术后皮肤坏死是一种罕见的并发症，可迅速导致假体部件深部感染。内侧腓肠肌转位皮瓣通常能提供足够的软组织覆盖，以挽救全膝关节置换术。然而，缺损位置的变化和肌皮瓣的移位可能会影响治疗效果。12例全膝关节置换术后患者接受了内侧腓肠肌转位皮瓣治疗。8例患者（第1组）需要皮瓣覆盖的皮肤缺损位于胫骨结节或髌腱上方。4例患者（第2组）缺损向近端延伸至髌骨或股四头肌肌腱。11例患者（92%）成功挽救了功能正常的全膝关节置换术。第1组所有患者的内侧腓肠肌皮瓣均一期愈合。第2组3例患者需要额外的筋膜皮瓣、外侧腓肠肌皮瓣或游离皮瓣覆盖，1例患者接受了膝上截肢。内侧腓肠肌皮瓣对于覆盖胫骨结节或髌腱上方的远端缺损最为有效。向近端延伸至髌骨或股四头肌肌腱的缺损更有可能需要额外的手术来实现足够的软组织覆盖。
治疗性研究，IV级（病例系列）。有关证据水平的完整描述，请参阅作者指南。
