Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York.
J Arthroplasty. 2018 Oct;33(10):3263-3267. doi: 10.1016/j.arth.2018.05.021. Epub 2018 May 23.
Soft-tissue deficiency is a potentially devastating complication of the infected total knee arthroplasty (TKA). Rotational muscle flaps are commonly used to address these defects. However, reported success rates vary widely.
We reviewed 26 consecutive patients who underwent rotational muscle flap surgery for full-thickness anterior soft-tissue defect during treatment of an infected TKA. Twenty-four cases used a medial gastrocnemius rotational flap, 1 used a lateral gastrocnemius flap, and 1 used a rectus femoris-vastus intermedius flap. Implant survival, recurrence of infection, and limb survival were reported. Patient and procedural characteristics were tested for association with failure using χ and Student t-test. Kaplan-Meier analysis was used to estimate the failure-free survival function.
Mean follow-up time was 3.3 years. Eighteen of 26 patients (69.2%) experienced recurrent infection requiring an average of 5.3 additional operations (range, 1-20). Five (19.2%) required arthrodesis while 6 (23.1%) eventually underwent above-the-knee amputation. Two patients (7.7%) died due to complications of revision surgery or persistent infection. Eleven patients (42.3%) were infection free with a retained prosthesis after treatment at a mean follow-up of 5.3 years (range, 0.7-18.0 years).
Rotational muscle flap coverage of soft-tissue defects in the setting of the infected TKA remains a viable salvage option. However, despite adequate tissue coverage, many patients experience recurrent infection requiring additional surgical treatment. Patients and surgeons should be aware of the potential high failure rates observed when treating these complex problems.
软组织缺损是感染性全膝关节置换术（TKA）的一种潜在破坏性并发症。旋转肌皮瓣常用于解决这些缺陷。然而，报道的成功率差异很大。
我们回顾了 26 例连续患者，这些患者在治疗感染性 TKA 时因全层前软组织缺损而行旋转肌皮瓣手术。24 例使用内侧比目鱼肌旋转皮瓣，1 例使用外侧比目鱼肌皮瓣，1 例使用股直肌-股中间肌皮瓣。报告了植入物存活率、感染复发和肢体存活率。使用 χ 和学生 t 检验测试患者和手术特征与失败的相关性。使用 Kaplan-Meier 分析估计失败无生存函数。
平均随访时间为 3.3 年。26 例患者中有 18 例（69.2%）经历了需要平均 5.3 次额外手术（范围为 1-20 次）的复发性感染。5 例（19.2%）需要融合，6 例（23.1%）最终行膝上截肢。由于翻修手术或持续感染的并发症，2 例患者（7.7%）死亡。11 例（42.3%）患者在经过治疗后感染得到控制，保留假体，平均随访 5.3 年（范围为 0.7-18.0 年）。
在感染性 TKA 中，旋转肌皮瓣覆盖软组织缺损仍然是一种可行的挽救选择。然而，尽管有足够的组织覆盖，许多患者仍会出现感染复发，需要额外的手术治疗。患者和外科医生应该意识到在治疗这些复杂问题时观察到的高失败率的潜在风险。
