用于感染性膝关节翻修术中软组织缺损闭合的皮瓣
Flaps for closure of soft tissue defects in infected revision knee arthroplasty.
作者信息
Suda Arnold J, Cieslik Angela, Grützner Paul A, Münzberg Matthias, Heppert Volkmar
机构信息
Department for Septic Surgery, Trauma Center Ludwigshafen, Ludwigshafen, Germany,
出版信息
Int Orthop. 2014 Jul;38(7):1387-92. doi: 10.1007/s00264-014-2316-z. Epub 2014 Mar 25.
PURPOSE
Total knee arthroplasty revision has wound healing deficits of up to 20 %. Defects in the knee region of multimorbid patients are hard to treat as complete explantation and revision arthroplasty is often too burdensome for them. In this study, we present our results with flaps for the treatment of defects after knee replacement, arthrodesis or osteosynthesis.
METHODS
Twenty-five patients (26 knees) with defects in the knee region were treated with flaps. Mean follow-up was 37 months (13-61) and the patients had a mean age of 72 years (49-85). A total of 39 flaps were performed (27 muscle flaps, seven fascio-cutaneous flaps and five free flaps).
RESULTS
Patients with more than three comorbidities showed higher risk of complications after surgery. Fifteen patients showed no infection at last follow up. Five patients received an arthrodesis of the knee, two showed persistent infection of the implant with fistula, and three were amputated above the knee.
CONCLUSIONS
Amputation could be avoided in 22 cases (85 %). The gastrocnemius muscle flap showed good results in the treatment of defects after arthroplasty or arthrodesis of the knee in multimorbid patients. This procedure can be used if further revision surgery is not indicated.
目的
全膝关节置换翻修术存在高达20%的伤口愈合缺陷。多病患者膝关节区域的缺损难以治疗，因为完全取出植入物并进行翻修关节成形术对他们来说往往负担过重。在本研究中，我们展示了使用皮瓣治疗膝关节置换、关节融合或骨固定术后缺损的结果。
方法
25例（26膝）膝关节区域有缺损的患者接受了皮瓣治疗。平均随访37个月（13 - 61个月），患者平均年龄72岁（49 - 85岁）。共进行了39次皮瓣手术（27例肌皮瓣、7例筋膜皮瓣和5例游离皮瓣）。
结果
患有三种以上合并症的患者术后并发症风险更高。15例患者在最后一次随访时无感染。5例患者接受了膝关节融合术，2例植入物持续感染并伴有瘘管，3例在膝关节以上截肢。
结论
22例（85%）患者避免了截肢。腓肠肌皮瓣在治疗多病患者膝关节置换或关节融合术后缺损方面效果良好。如果不适合进一步的翻修手术，可以采用此方法。
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