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Beitragstitel Multi-staged reconstruction of anterior knee defect after TKA infections with pedicled medial gastrocnemius flap and split thickness skin graft after temporary coverage with Epigard and negative-pressure wound conditioning: a clinical case
Beitragscode P58
Autoren
  1. Nastassia Pralong-Guanziroli HUG Vortragender
  2. Carlo Oranges HUG Hôpitaux Universitaires Genève
  3. Domizio Suva HUG Hôpitaux Universitaires Genève
Präsentationsform Poster
Themengebiete
  • A07 - Spezialgebiet 2 | Infekte
Abstract Background: Soft tissue defects on the knee with TKA underneath are challenging because of the risk of infections. Multiples procedures increase the occurrence of defects, in particular over the knee because of skin tension. Reconstruction of soft tissue defects with pedicled medial gastrocnemius flap and split thickness skin graft has shown excellent results and the technique is reproducible with minimal donor site morbidity. We present a clinical case of multi-staged reconstruction which can be adopted in case of unsure vascularization.
Case Presentation: A 64 years old female with past history of left TKA in 2010 presented to the ED from a rehabilitation unit because of scar opening and implant insufficiency 2.5 weeks after a second osteosynthesis of a left patellar fracture. The third patellar osteosynthesis surgery was complicated by a postoperative acute infection of the knee by s. epidermidis, requiring the patellar implant and TKA removal with placement of an antibiotic-impregnated mobile cement spacer. A VAC system was applied to cover the defect on the anterior aspect of the knee until control of the acute phase of the infection with IV AB-therapy and knee irrigations. The defect was reconstructed with a pedicled medial gastrocnemius flap, but due to uncertain intraoperative vascularization, a multi-staged approach was adopted: immediate coverage with Epigard and multiple changes of negative-pressure dressings before definitive split thickness skin graft. Complete wound healing was observed after 2 weeks, with AB-therapy maintained for 12 weeks. The patient was transferred in a rehabilitation unit, unfortunately she fell and had a proximal femoral IMN on the same side with a subluxation of the mobile spacer, which was changed for a fixed spacer. The knee was approached through elevation of the flap, with excellent wound healing.
Discussion: Iterative procedures in a short-time are a risk of postoperative infections. This case shows how it can tragically progress into a soft-tissue coverage defect, worsening the infection prognosis. Orthoplastics procedures as pedicled medial gastrocnemius flaps and split thickness skin grafts are accepted options to provide a good coverage over sensitive areas, in particular with underlying material such as prosthetics implants. In case of long term AB-treatment before reimplantation, they provide a clean and vascularized protection before the definitive surgery and can be easily approached during the procedure.