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[Soft tissue healing in infected arthroplasty]
V Heppert1, P Thoele, A J Suda
1Abteilung für septische Chirurgie, Knochen-, Gelenk- und Protheseninfektionen, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany. volkmar.heppert@bgu-ludwigshafen.de
Objective:
Soft-tissue defect coverage with well vascularized tissue (musculocutaneous or fasciocutaneous) in the arthroplasty setting. Where arthroplasty has been removed due to infection, as a muscle flap to close infected cavities.
Indications:
Soft tissue defects, wound-edge necrosis in arthroplasty, and persistent infection in Girdlestone patients.
Contraindications:
Moribund patients.
Surgical Technique:
Pedicled flap: as far as possible, lift the flap as an island flap to increase coverage. Then suture the flap into the defect (split skin graft where appropriate). Free flap: lift the flap and prepare a vascular pedicle for anastomosis. Suture the flap into the site and create arterial and vascular micro-anastomoses (split skin graft where appropriate).
Postoperative Management:
Position the extremity according to the flap type used. Use 500 ml HES (hydroxyethyl starch) 6% for 5 days. Avoid compression of the pedicle or anastomosis area. Flaps are generally autonomous after 3 weeks.
Results:
The survival rate for both flap types, free and pedicled, is >90%. The flap survival rate should not be confused with the healing rate for infected arthroplasty.
