Müller Seraina L C, Kuehl Richard, Schaefer Dirk J, Morgenstern Mario, Clauss Martin, Osinga Rik
Department of Plastic Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel Basel Switzerland.
Center for Musculoskeletal Infections (ZMSI) University Hospital Basel Basel Switzerland.
J Exp Orthop. 2024 Jul 6;11(3):e12089. doi: 10.1002/jeo2.12089. eCollection 2024 Jul.
Periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) presents significant challenges, especially in elderly and comorbid patients, often necessitating revision surgeries. We report on a series of patients with confirmed PJI of the knee and concomitant soft-tissue/extensor apparatus defects, treated by using pedicled myocutaneous medial or lateral sural artery perforator (MSAP/LSAP) gastrocnemius flaps.
Our retrospective study at the Center for Musculoskeletal Infections, included patients with knee PJI undergoing pedicled myocutaneous MSAP/LSAP gastrocnemius flap reconstruction for combined soft tissue and extensor apparatus defects. The tendinous back of the gastrocnemius muscle was used and, if required, the Achilles tendon for extensor apparatus reconstruction, with the skin island addressing the cutaneous defect. Perioperative complications and postoperative outcomes after 1 year were evaluated, including functional and clinical assessments with the American Knee Society Score (AKSS).
Eight patients (mean age 73 years; five female) were included, predominantly with Staphylococcus aureus infections. Six patients involved isolated MSAP flaps, two were extended with the Achilles tendon. The median time for wound healing was 9 days. Short-term follow-up showed successful reconstruction in seven patients, with minor wound dehiscence in one patient. One patient required flap revision for a perigenicular haemato-seroma and two patients were diagnosed with new haematogenous PJI infection. Significant improvement in AKSS scores after surgery was observed (functional AKSS: median 33-85; clinical AKSS: median 64-91, = 0.001).
Pedicled myocutaneous MSAP/LSAP gastrocnemius flaps offer a safe, reliable and versatile option for reconstructing combined soft tissue and extensor apparatus defects in PJI after TKA. This approach yields excellent functional outcomes with minimal peri- and postoperative complications, which is particularly beneficial in elderly and comorbid patients and feasible in settings without microsurgical availability.
Level IV.
全膝关节置换术（TKA）后假体周围关节感染（PJI）带来了重大挑战，尤其是在老年和合并症患者中，常常需要进行翻修手术。我们报告了一系列确诊为膝关节PJI且伴有软组织/伸肌装置缺损的患者，采用带蒂肌皮腓肠内侧或外侧动脉穿支（MSAP/LSAP）腓肠肌皮瓣进行治疗。
我们在肌肉骨骼感染中心进行的回顾性研究，纳入了因软组织和伸肌装置联合缺损而接受带蒂肌皮MSAP/LSAP腓肠肌皮瓣重建的膝关节PJI患者。使用腓肠肌的肌腱后部，必要时使用跟腱进行伸肌装置重建，皮岛用于解决皮肤缺损。评估围手术期并发症和1年后的术后结果，包括使用美国膝关节协会评分（AKSS）进行功能和临床评估。
纳入8例患者（平均年龄73岁；5例女性），主要感染病原体为金黄色葡萄球菌。6例患者采用单纯MSAP皮瓣，2例患者加用跟腱延长。伤口愈合的中位时间为9天。短期随访显示7例患者重建成功，1例患者出现轻微伤口裂开。1例患者因关节周围血肿-血清肿需要皮瓣翻修，2例患者被诊断为新的血源性PJI感染。术后观察到AKSS评分有显著改善（功能AKSS：中位数从33提高到85；临床AKSS：中位数从64提高到91，P = 0.001）。
带蒂肌皮MSAP/LSAP腓肠肌皮瓣为TKA术后PJI中软组织和伸肌装置联合缺损的重建提供了一种安全、可靠且通用的选择。这种方法产生了极佳的功能结果，围手术期和术后并发症最少，这在老年和合并症患者中尤其有益，并且在没有显微外科手术条件的情况下也是可行的。
IV级。
