ObjectiveTo investigate the risk factors of skin necrosis around incision after total knee arthroplasty (TKA),and explore the measures of prevention and treatment. MethodsBetween June 2007 and June 2013,7 patients with skin necrosis around incision after TKA were treated.There were 5 males and 2 females with an average age of 69 years (range,59-78 years),including osteoarthritis in 4 cases,traumatic arthritis in 2 cases,and rheumatoid arthritis in 1 case.Two cases complicated by diabetes,and 2 cases by hypertension; 1 case received long-term hormone therapy; and 2 cases had a history of smoking.Scar was seen near knee joint in 2 cases.The skin necrosis ranged from 10 cm×2 cm to 13 cm×8 cm.The time from TKA to debridement was 7-15 days (mean,12 days).After thorough debridement,the saphenous artery skin flap,medial head of gastrocnemius muscle flap,lateral head of gastrocnemius muscle flap were used in 4 cases,2 cases,and 1 case respectively; reconstruction of patellar ligament was performed in 2 cases.Donor sites were repaired by split-thickness skin graft. ResultsAll the flaps and myocutaneous flaps survived well,and all wounds healed by first intention.At donor site,the grafted skins survived and wounds healed by first intention.No early complication occurred.All cases were followed up 6-12 months (mean,7.8 months).The flaps and myocutaneous flaps had good texture and appearance; no prosthetic loosening and displacement happened,no secondary infection was observed after operation.The knee range of motion was 45-110° (mean,85°) at 6 months after operation.According to the Knee Society Score (KSS),the results were excellent in 3 cases,good in 2 cases,general in 1 case,and poor in 1 case at 6 months after operation. ConclusionEarly discovery,thoroughly debridement,and timely repair with axial pattern flap or myocutaneous flap are the key factors to treat skin necrosis around incision after TKA and save the artificial prosthesis.
Objective To investigate the effectiveness of tissue flap grafting and sequential bone lengthening for repairing severe soft tissue and bone defects of the lower extremity after burn injury. Methods Between January 2010 and December 2015, 11 cases of large segmental bone and soft tissue defects in the leg were treated. There were 10 males and 1 female, with a mean age of 28 years (range, 19-37 years). The causes included traffic accident in 8 cases, high voltage electric burn in 2 cases, CO poisoning burn in 1 case. The time from injury to admission was 3-14 days (mean, 6.5 days). The bone defect length was 8-18 cm (mean,14 cm); the skin soft tissue defect ranged from 13 cm × 8 cm to 25 cm × 19 cm. After complete removal of necrotic tissue and lesions of the femur or the tibia, the tissue flaps were used to repair soft tissue defect of the lower extremity in one-stage operation; bone defect was treated by Orthofix single side external fixation or Ilizarov ring external fixation in two-stage operation. Results Eleven flaps survived completely, primary healing of incision was obtained in the others except for 1 patient who had necrotic bone infection, which was cured after removing necrosed femoral bone and filling with antibiotic bone cement spacer. During bone lengthening, pin tract infection occurred in 1 patient, and infection was controlled after dressing change. Bone lengthening ranged from 8 to 18 cm, with an average of 14 cm. After prolonged extension, the external fixator was retained for 4-12 months (mean, 6.5 months). All bone defects were repaired with bone healing time of 12-22 months (mean, 17 months). All patients were followed up 8-24 months (mean, 15 months). No vascular and neurological complication occurred during operation; no osteomyelitis or re-fracture occurred after operation, and the recovery of the lower extremity function was good. Conclusion Tissue flap grafting combined with bone lengthening is an effective method to repair severe bone and soft tissue defects of lower extremity.
Objective To investigate the effectiveness of distally pedicled peroneus brevis muscle flaps and reverse sural neurovascular island flaps for post-traumatic chronic calcaneal osteomyelitis and soft tissue defects. Methods Between January 2008 and January 2012, 9 patients suffering from post-traumatic chronic calcaneal osteomyelitis and soft tissue defects were treated, including 8 males and 1 female with an average age of 33 years (range, 18-46 years). The left heel was involved in 4 cases, and right heel in 5 cases. Infection occurred after reduction and internal fixation of closed fractures of the calcaneus in 7 cases, and open calcaneal fracture and soft tissue defect in 2 cases. The disease duration was 2 months to 3 years (mean, 5 months). Purulent secretion, tissue necrosis, or sinus formation was observed in all wounds. The results of bacterial culture were positive. X-ray and CT examination showed uneven density of calcaneus and bone cavity or dead bone formation. After thorough debridement, the size of bone defect ranged from 3 cm × 3 cm × 3 cm to 6 cm × 4 cm × 3 cm; the size of soft tissue defect ranged from 7 cm × 3 cm to 12 cm × 7 cm. The distally pedicled peroneus brevis muscle flaps (11 cm × 3 cm-16 cm × 4 cm) were used for bone defect repair, and reverse sural neurovascular island flaps (8 cm × 4 cm-14 cm × 8 cm) for soft tissue defect. The donor site was directly sutured in 6 cases and repaired by skin graft in 3 cases. Results After operation, reverse sural neurovascular island flaps survived in 9 cases, and all wounds healed by first intention. No necrosis or liquefaction of distally pedicled peroneus brevis muscle flaps was observed. Incision at donor site healed by first intention, and skin grafts at donor site survived. All cases were followed up 6-24 months (mean, 13.5 months). The flaps had good texture. No recurrence of osteomyelitis was observed. Basic weight-bearing walking function was restorated. No obvious calcaneal collapse happened. Conclusion The distally pedicled peroneus brevis muscle flap combined with reverse sural neurovascular island flap is one of the effective methods to treat post-traumatic chronic calcaneal osteomyelitis with soft tissue defect, with the advantages of simple operation and good blood supply.