DOI QR코드

DOI QR Code

Soft Tissue Reconstruction Using Perforator Flap in Patients with Infected Knee Prosthesis

  • Lee, Jin Won (Department of Plastic and Reconstructive Surgery, Chonbuk National University Medical School) ;
  • Kim, Sung Hoon (Department of Plastic and Reconstructive Surgery, Chonbuk National University Medical School) ;
  • Yoo, Jun Ho (Department of Plastic and Reconstructive Surgery, Chonbuk National University Medical School) ;
  • Roh, Si Gyun (Department of Plastic and Reconstructive Surgery, Chonbuk National University Medical School) ;
  • Lee, Nae Ho (Department of Plastic and Reconstructive Surgery, Chonbuk National University Medical School) ;
  • Yang, Kyoung Moo (Department of Plastic and Reconstructive Surgery, Chonbuk National University Medical School)
  • 투고 : 2014.11.03
  • 심사 : 2014.11.18
  • 발행 : 2014.11.30

초록

Purpose: Soft-tissue reconstruction in the knee area requires thin, pliable, and tough skin. The range of motion of the knee also acts as a limitation in using only local flaps for coverage. The author has successfully used various perforator flaps for soft tissue reconstruction around the knee while preserving its functional and cosmetic characteristics. Materials and Methods: Out of the twenty patients assessed from April 2009 to March 2011, seven received anterolateral thigh perforator flaps, four received medial sural perforator island flaps, four received lateral supragenicular perforaor perforator flaps, and five received medial genicular artery flaps. The age of the patients ranged from 44 to 79 and the size of the defects ranged from $4{\times}5cm$ to $17{\times}11cm$. Fifteen of the twenty patients had histories of total knee replacement (TKR) surgery. Results: There were no flap losses in any of the twenty patients assessed. Two patients showed partial losses in the distal area of the flap, but were treated through careful wound care. One patient presented with pedicle adhesion at the drainage site from a past TKR, but it did not hinder the flap survival. Primary closure at the donor site was possible in nine patients, while split skin graft was necessary for the other 13. Conclusion: In soft tissue reconstruction of the knee, various perforator flaps can be used depending on the condition of the preoperation scar, wound site, and size. It also proved to provide better functional and cosmetic results than in primary wound closure or skin grafts.

키워드

참고문헌

  1. Salibian AH, Anzel SH. Salvage of an infected total knee prosthesis with medial and lateral gastrocnemius muscle flaps. A case report. J Bone Joint Surg Am 1983;65:681-4. https://doi.org/10.2106/00004623-198365050-00015
  2. Casey WJ 3rd, Rebecca AM, Krochmal DJ, Kim HY, Hemminger BJ, Clarke HD, et al. Prophylactic flap reconstruction of the knee prior to total knee arthroplasty in high-risk patients. Ann Plast Surg 2011;66:381-7. https://doi.org/10.1097/SAP.0b013e3181e37c04
  3. Bengston S, Knutson K, Lidgren L. Treatment of infected knee arthroplasty. Clin Orthop Relat Res 1989;(245):173-8.
  4. McPherson EJ, Patzakis MJ, Gross JE, Holtom PD, Song M, Dorr LD. Infected total knee arthroplasty. Two-stage reimplantation with a gastrocnemius rotational flap. Clin Orthop Relat Res 1997;(341):73-81.
  5. Sanders R, O'Neill T. The gastrocnemius myocutaneous flap used as a over for the exposed knee prosthesis. J Bone Joint Surg Br 1981;63:383-6.
  6. Tiengo C, Macchi V, Vigato E, Porzionato A, Stecco C, Azzena B, et al. Reversed gracilis pedicle flap for coverage of a total knee prosthesis. J Bone Joint Surg Am 2010;92:1640-6. https://doi.org/10.2106/JBJS.I.00195
  7. Arnold PG, Prunes-Carrillo F. Vastus medialis muscle flap for functional closure of the exposed knee joint. Plast Reconstr Surg 1981;68:69-72. https://doi.org/10.1097/00006534-198107000-00014
  8. Galat DD, McGovern SC, Larson DR, Harrington JR, Hanssen AD, Clarke HD. Surgical treatment of early wound complications following primary total knee arthroplasty. J Bone Joint Surg Am 2009;91:48-54. https://doi.org/10.2106/JBJS.G.01371
  9. Menderes A, Demirdover C, Yilmaz M, Vayvada H, Barutcu A. Reconstruction of soft tissue defects following total knee arthroplasty. Knee 2002;9:215-9. https://doi.org/10.1016/S0968-0160(02)00010-8
  10. Wiedner M, Koch H, Scharnagl E. The superior lateral genicular artery flap for soft-tissue reconstruction around the knee: clinical experience and review of the literature. Ann Plast Surg 2011;66:388-92. https://doi.org/10.1097/SAP.0b013e3181e37627
  11. Ries MD, Bozic KJ. Medial gastrocnemius flap coverage for treatment of skin necrosis after total knee arthroplasty. Clin Orthop Relat Res 2006;446:186-92. https://doi.org/10.1097/01.blo.0000218723.21720.51
  12. Chen CY, Hsieh CH, Kuo YR, Jeng SF. An anterolateral thigh perforator flap from the ipsilateral thigh for soft-tissue reconstruction around the knee. Plast Reconstr Surg 2007;120: 470-3. https://doi.org/10.1097/01.prs.0000267432.03348.97
  13. Hallock GG. Salvage of total knee arthroplasty with local fasciocutaneous flaps. J Bone Joint Surg Am 1990;72:1236-9. https://doi.org/10.2106/00004623-199072080-00017
  14. Kim HH, Jeong JH, Seul JH, Cho BC. New design and identification of the medial sural perforator flap: an anatomical study and its clinical applications. Plast Reconstr Surg 2006;117:1609-18. https://doi.org/10.1097/01.prs.0000207077.19601.86