Greenberg B, LaRossa D, Lotke P A, Murphy J B, Noone R B
Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia.
Plast Reconstr Surg. 1989 Jan;83(1):85-9, 97-9. doi: 10.1097/00006534-198901000-00016.
Total-knee arthroplasty has provided many patients with excellent long-term functional results. However, exposure of a total-knee replacement usually eventuates in failure. The relatively superficial location of the prosthesis, the need for early active motion, previous surgical incisions, and a variety of systemic factors may militate against early wound healing. Restoration of well-vascularized soft-tissue cover can salvage an otherwise disastrous situation. The authors recommend early operative intervention upon observation of wound breakdown, devitalized skin edges, or significant subcutaneous infection leading to necrotic overlying skin. The operative procedure found to salvage the majority of prostheses consists of adequate debridement, antibiotic irrigation (of the joint, if exposed), and coverage with a well-vascularized muscle flap, preferably the medial gastrocnemius muscle. The operative technique and ultimate long-term outcome are reviewed based on experience with 10 consecutive patients presenting with a jeopardized knee prosthesis. Follow-up ranged from 1 to 6 years. Representative case histories are presented.
全膝关节置换术为许多患者带来了出色的长期功能效果。然而，全膝关节置换假体的暴露通常最终会导致失败。假体相对表浅的位置、早期主动活动的需求、既往手术切口以及多种全身因素可能不利于伤口早期愈合。恢复血运良好的软组织覆盖可挽救原本灾难性的局面。作者建议，一旦观察到伤口裂开、皮肤边缘失活或导致上方皮肤坏死的严重皮下感染，应尽早进行手术干预。经证实可挽救大多数假体的手术方法包括充分清创、抗生素冲洗（若关节暴露则冲洗关节）以及用血运良好的肌瓣覆盖，最好是腓肠内侧肌。基于对10例连续出现膝关节假体岌岌可危情况的患者的经验，对手术技术和最终长期结果进行了回顾。随访时间为1至6年。并展示了代表性的病例史。
