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Wound necrosis after total knee arthroplasty
Vittorio Patella1, Domenico Speciale, Silvio Patella
1Italian Society of Orthopedic Surgeons, Unità Operativa Ortopedia e Traumatologia II-University of Bari, Bari, Italy.
Orthopedics
|March 19, 2009
Summary
Skin necrosis after total knee arthroplasty (TKA) can occur without risk factors. This case highlights successful treatment with debridement, vacuum-assisted closure, and skin grafting for a full recovery.
Area of Science:
- Orthopedic Surgery
- Wound Complications
Background:
- Skin necrosis and deep infection are known complications following total knee arthroplasty (TKA).
- Predisposing factors include immunosuppression, malnutrition, steroid use, rheumatoid arthritis, multiple scars, and vascular disease, alongside prolonged tourniquet times and early knee flexion.
Observation:
- This article details a rare case of skin necrosis in a 78-year-old woman with no prior comorbidities who underwent a cemented TKA for primary osteoarthritis.
- The patient developed fever and wound issues three days postoperatively, progressing to skin necrosis.
Findings:
- The complication was managed with surgical debridement, antibiotic therapy, local wound care, and vacuum-assisted closure.
- Subsequent soft tissue coverage was achieved with skin grafting, leading to complete recovery within three months.
Implications:
- This case underscores that TKA patients can develop skin necrosis even without apparent risk factors.
- Successful management involves a multi-modal approach including surgical intervention and advanced wound care techniques.
- Skin grafting proved effective for soft tissue coverage, restoring good range of motion and functional outcomes.
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