Video Gallery

Video Gallery

To View the Video

Rotational Muscle Flap Coverage for Soft Tissue Defects in the Treatment of the Infected Total Knee Arthroplasty

February 10, 2018

Contributors: Jeffrey A Geller, MD; R Kumar Kadiyala, MD, PhD; Akshay Lakra, MBBS, MD; Taylor Murtaugh, BS; Luke Anthony Reda; Roshan P Shah, MD, JD; Shay Ivan Warren, BA; Herbert John Cooper, MD; Herbert John Cooper, MD

Introduction: Management of the periprosthetic soft tissues may be a challenge in patients undergoing treatment for an infected total knee arthroplasty (TKA) implant. Particularly in patients who have undergone multiple revision procedures, the compromised soft tissues may progress to complicated soft-tissue defects, which predispose patients to treatment failure or limb loss. Coverage of the soft-tissue defect with a rotational muscle flap may be required in these difficult patient scenarios. This video reports a single institution's experience using rotational muscle flaps for coverage of soft-tissue defects in patients undergoing treatment for an infected TKA implant. Methods: Between 2007 and 2017, rotational flaps were used to manage full-thickness anterior soft-tissue deficiency in 16 patients undergoing treatment for an infected TKA implant. The mean follow-up was 1.88 years (range, 0.1 to 6.1 years). The study group included 7 men and 9 women, with a mean age of 67.2 years (range, 44 to 87 years). The mean BMI of the patients was 29.6 kg/m2. A medial gastrocnemius rotational flap was used in 14 patients, a myofascial flap was used in 1 patient, and a gastrocnemius-soleus-calcaneus pedicle flap was used in 1 patient. Implant survival, recurrence of infection, and limb survival were reported. Patient and procedural characteristics were tested for association with failure. Survivorship was calculated using Cox proportional hazards modeling. Results: A persistent or recurrent infection occurred in 10 of the 16 patients (62.5%) at latest follow-up. Survivorship of the revision TKA prosthesis was 43.8%. Although no flap-related complications occurred, nine patients underwent a total of 48 additional revision procedures during the study period. Five of the 16 patients (31.3%) eventually underwent an above-the-knee amputation, and one patient currently is considering an above-the-knee amputation. In addition, one patient underwent arthrodesis, and one patient died as a result of cardiopulmonary arrest secondary to sepsis from a persistent knee infection. No characteristics were identified as associated with failure. Infection-free survival of the prosthesis occurred in only 6 of the 16 patients (37.5%). Discussion and Conclusion: Rotational muscle flaps were used to manage complicated soft-tissue defects in patients undergoing treatment for a periprosthetic joint infection after TKA. Although almost 40% of the patients experienced positive short-term to midterm limb salvage outcomes, our data show that periprosthetic joint infections are a severe complication of TKA that may be difficult to manage in patients with an overlying soft-tissue defect. The high number of patients who experienced recurrence of infection and loss of their prosthesis or limb likely reflects the complexity of the cases rather than flap coverage complications. This data can be used during the counseling of patients in whom these challenging clinical problems occur.

Results for "Adult Reconstruction"

2 of 22
2 of 22

X