Garbedian Shawn, Sternheim Amir, Backstein David
Mount Sinai Hospital, Room 476, 600 University Ave, Toronto, Ontario, M5G 1X5, Canada.
Orthopedics. 2011 Sep 9;34(9):e516-8. doi: 10.3928/01477447-20110714-42.
It is important to avoid underestimating the significance of wound complications following total knee arthroplasty (TKA). Expedient and aggressive care is recommended. Understanding the blood supply to the skin around the knee and measures to prevent wound complications are fundamental to preventing wound problems. A detailed patient history and physical examination will identify high-risk patients and any modifiable risk factors. Operative techniques such as raising full-thickness skin flaps and judicious placement of skin incisions in the presence of pre-existing scars can greatly reduce the incidence of wound problems. The first step in treating wound problems is recognizing when a problem is present and knowing when a minor problem can turn into a major one. Superficial infections or stitch abscesses can be treated with conservative treatment. However, the surgeon should have a low threshold to revert to surgical management if drainage persists. Skin necrosis or non-viable skin must be excised in the operating room, and the presence of a deep infection must be diagnosed by joint aspiration. The appropriate course of action in dealing with deep infection is dependent on the duration elapsed since the index procedure. The ability to perform a medial gastrocnemius muscle flap and skin graft is an invaluable skill in complex cases where primary wound closure cannot be achieved. Meticulous attention to detail during surgery and aggressive surgical treatment of wound complications can be the difference in saving the knee.
避免低估全膝关节置换术（TKA）后伤口并发症的重要性至关重要。建议采取迅速且积极的护理措施。了解膝关节周围皮肤的血液供应以及预防伤口并发症的措施是预防伤口问题的基础。详细的患者病史和体格检查将识别出高危患者以及任何可改变的风险因素。诸如掀起全层皮瓣以及在存在既往瘢痕的情况下明智地放置皮肤切口等手术技术，可大大降低伤口问题的发生率。治疗伤口问题的第一步是识别问题何时出现，并知晓小问题何时会演变成大问题。浅表感染或缝线脓肿可用保守治疗。然而，如果持续引流，外科医生应毫不犹豫地转为手术治疗。皮肤坏死或无活力的皮肤必须在手术室切除，深部感染必须通过关节穿刺抽吸来诊断。处理深部感染的适当行动方案取决于距初次手术的时间。在无法实现一期伤口闭合的复杂病例中，施行内侧腓肠肌肌瓣和皮肤移植的能力是一项非常宝贵的技能。手术期间对细节的精心关注以及对伤口并发症的积极手术治疗可能是挽救膝关节的关键所在。
