Coombs Demetrius M, Churchill Jessica, Cartwright Paul, Chughtai Morad, Sultan Assem A, Samuel Linsen T, Moskal Joseph T, Hendrickson Mark F, Mont Michael A
Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio.
Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
J Knee Surg. 2020 Jul;33(7):732-744. doi: 10.1055/s-0039-1684012. Epub 2019 Apr 8.
Deep soft tissue defects after complicated primary or revision total knee arthroplasty (TKA) can be devastating to the patient and technically challenging. The purpose of this review was to (1) discuss different methods used to provide coverage for deep defects of the knee following TKA, as well as to (2) report on their success rates. A comprehensive literature search was performed. Reports were only included if they (1) were case series, (2) were level III studies or above (including retrospective cohort studies and meta-analyses), (3) were in English, and (4) discussed the outcome of graft or flap coverage of soft tissue defects after total knee arthroplasty. A total of 28 case series and four retrospective comparative studies were retrieved. In 16 studies, 195 out of 241 patients who received gastrocnemius flaps (81%) experienced successful outcomes. In seven studies including 84 patients that underwent fasciocutaneous flap coverage, over 90% of patients experienced successful outcomes. In the four studies examining 144 patients with delayed versus prophylactic soft tissue reconstruction, up to 81% of patients experienced a successful outcome. Various factors must be taken into consideration when assessing full-thickness defects over a TKA and collaboration between plastic and orthopaedic surgeons is required to select the optimal approach.
复杂的初次或翻修全膝关节置换术（TKA）后出现的深部软组织缺损，对患者来说可能是灾难性的，在技术上也具有挑战性。本综述的目的是：（1）讨论用于覆盖TKA后膝关节深部缺损的不同方法，以及（2）报告这些方法的成功率。我们进行了全面的文献检索。纳入的报告需满足以下条件：（1）为病例系列研究；（2）为III级及以上研究（包括回顾性队列研究和荟萃分析）；（3）为英文文献；（4）讨论了全膝关节置换术后软组织缺损的移植物或皮瓣覆盖的结果。共检索到28个病例系列和4个回顾性比较研究。在16项研究中，241例接受腓肠肌皮瓣移植的患者中有195例（81%）获得成功。在7项包括84例接受筋膜皮瓣覆盖的患者的研究中，超过90%的患者获得成功。在4项对144例延迟与预防性软组织重建患者进行研究中，高达81%的患者获得成功。在评估TKA上的全层缺损时，必须考虑各种因素，并且整形外科和骨科医生之间需要合作以选择最佳方法。
