[Soft tissue healing in infected arthroplasty].

OBJECTIVE

Soft-tissue defect coverage with well vascularized tissue (musculocutaneous or fasciocutaneous) in the arthroplasty setting. Where arthroplasty has been removed due to infection, as a muscle flap to close infected cavities.

INDICATIONS

Soft tissue defects, wound-edge necrosis in arthroplasty, and persistent infection in Girdlestone patients.

CONTRAINDICATIONS

Moribund patients.

SURGICAL TECHNIQUE

Pedicled flap: as far as possible, lift the flap as an island flap to increase coverage. Then suture the flap into the defect (split skin graft where appropriate). Free flap: lift the flap and prepare a vascular pedicle for anastomosis. Suture the flap into the site and create arterial and vascular micro-anastomoses (split skin graft where appropriate).

POSTOPERATIVE MANAGEMENT

Position the extremity according to the flap type used. Use 500 ml HES (hydroxyethyl starch) 6% for 5 days. Avoid compression of the pedicle or anastomosis area. Flaps are generally autonomous after 3 weeks.

RESULTS

The survival rate for both flap types, free and pedicled, is >90%. The flap survival rate should not be confused with the healing rate for infected arthroplasty.