Sullivan Mikaela H, Gagnet Paul J, Labott Joshua R, Salomao Diva R, Houdek Matthew T
From the Department of Orthopedic Surgery (Dr. Sullivan, Dr. Gagnet, Dr. Labott, Dr. Houdek); and the Department of Laboratory Medicine and Pathology (Dr. Salomao), Mayo Clinic, Rochester, MN.
J Am Acad Orthop Surg Glob Res Rev. 2025 Mar 14;9(3). doi: 10.5435/JAAOSGlobal-D-24-00293. eCollection 2025 Mar 1.
Three years after endoprosthetic reconstruction of the proximal tibia, a patient presented with a skin ulceration near the surgical site. The knee was not clinically infected, but the patient had elevated serum cobalt levels. Dermatological evaluation diagnosed a friction ulcer. The ulcer failed to heal, and the patient underwent débridement and local flap advancement. Cultures grew Staphylococcus epidermidis, and they were treated with antibiotics. The ulceration recurred and repeated limb salvage was discussed, although eventually, the patient elected to undergo amputation. Pathology from the resected ulcer showed fibrinoid necrosis with aseptic lymphocytic vasculitis-associated lesion.
在胫骨近端进行人工关节置换重建三年后，一名患者在手术部位附近出现皮肤溃疡。临床检查发现膝关节未感染，但患者血清钴水平升高。皮肤科评估诊断为摩擦性溃疡。溃疡未能愈合，患者接受了清创术和局部皮瓣推进术。培养物中生长出表皮葡萄球菌，患者接受了抗生素治疗。溃疡复发，讨论了再次保肢治疗，尽管最终患者选择了截肢。切除溃疡的病理显示为纤维蛋白样坏死伴无菌性淋巴细胞性血管炎相关病变。
