Osei Daniel A, Rebehn Kelsey A, Boyer Martin I
From the Department of Surgery, Washington University School of Medicine, St. Louis, MO.
J Am Acad Orthop Surg. 2016 Nov;24(11):769-779. doi: 10.5435/JAAOS-D-15-00241.
Wound healing complications associated with total knee arthroplasty present a considerable challenge to the orthopaedic surgeon. To ensure preservation of a functional joint, the management of periprosthetic soft-tissue defects around the knee requires rapid assessment, early and aggressive débridement, and durable, contoured coverage. Several reconstructive options are available to tailor soft-tissue coverage to the location, size, and depth of the wound. Special consideration should be given to the timing of the intervention, management of infection, and prosthesis salvage. The merits of each reconstructive option, including perforator, fasciocutaneous, muscular, and free microvascular flaps, should be weighed to select the most appropriate option. The proposed approach can guide surgeons in treating patients with these complex soft-tissue defects.
与全膝关节置换术相关的伤口愈合并发症给骨科医生带来了相当大的挑战。为确保保留功能正常的关节,膝关节周围假体周围软组织缺损的处理需要快速评估、早期积极清创以及持久、贴合的覆盖。有多种重建选择可根据伤口的位置、大小和深度来定制软组织覆盖。应特别考虑干预时机、感染管理和假体挽救。应权衡每种重建选择的优点,包括穿支皮瓣、筋膜皮瓣、肌皮瓣和游离微血管皮瓣,以选择最合适的选项。所提出的方法可为外科医生治疗这些复杂软组织缺损的患者提供指导。