Kumar Taruni, Holmes Cameron, Burko Igor, Chaffin Abigail E
Tulane University School of Medicine, New Orleans, Louisiana.
Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
Eplasty. 2023 Jul 6;23:e41. eCollection 2023.
Soft tissue loss following total knee arthroplasty can result in catastrophic complications. Defects can be covered using various flaps and grafts, including fasciocutaneous flaps. Here, we discuss one case of double bipedicled "bucket-handle" local advancement flaps used for a nonhealing midline knee dehiscence wound following total knee arthroplasty.
Flaps were planned using perforators identified with forward-looking infrared (FLIR) thermal imaging. Two bucket-handle bipedicled flaps were used for repair. Autologous split-thickness skin grafts were used for the donor sites.
FLIR imaging was used for flap monitoring. Apart from one site of superficial epidermolysis that healed with local wound care, there were no postoperative complications.
This case demonstrates the successful use of double bipedicled local advancement flaps to reconstruct a defect following a total knee arthroplasty. These flaps minimize donor site morbidity, provide adequate coverage, allow for tension-free closures, and have reliable vascular supplies. FLIR thermal imaging is an accessible and useful tool in designing and monitoring flaps.
全膝关节置换术后软组织缺损可导致灾难性并发症。缺损可用各种皮瓣和移植物覆盖，包括筋膜皮瓣。在此，我们讨论一例双蒂“桶柄状”局部推进皮瓣用于全膝关节置换术后膝关节中线不愈合裂开伤口的病例。
使用前瞻性红外（FLIR）热成像识别穿支血管来设计皮瓣。使用两个桶柄状双蒂皮瓣进行修复。供区采用自体中厚皮片移植。
FLIR成像用于皮瓣监测。除一处浅表表皮松解经局部伤口护理愈合外，无术后并发症。
该病例证明双蒂局部推进皮瓣成功用于全膝关节置换术后缺损的重建。这些皮瓣将供区并发症降至最低，提供足够的覆盖，实现无张力缝合，且血管供应可靠。FLIR热成像在皮瓣设计和监测中是一种易于获得且有用的工具。
