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Muscle-flap coverage of exposed endoprostheses
M A Lesavoy1, T J Dubrow, P A Wackym
1Division of Plastic and Reconstructive Surgery, UCLA Medical Center.
Plastic and Reconstructive Surgery
|January 1, 1989
Summary
Orthopedic surgeons can now preserve endoprostheses with exposed wounds using a new debridement and flap coverage protocol. This approach avoids implant removal, infection, and amputation, enabling early mobilization and shorter hospital stays.
Area of Science:
- Orthopedics
- Reconstructive Surgery
Background:
- Traditional management for dehiscent wounds over endoprostheses involves implant removal and delayed reconstruction.
- Exposed endoprostheses pose a significant risk of infection and loss of limb function.
Observation:
- A novel protocol was applied to four patients with exposed endoprostheses.
- This protocol involved thorough soft-tissue debridement and myocutaneous or muscle-flap coverage.
- The prostheses were used for total-joint replacement or limb salvage.
Findings:
- All four endoprostheses and extremities were successfully salvaged without removal or exchange.
- No infections developed following the one-stage procedure.
- The new management protocol demonstrated successful limb salvage.
Implications:
- Late aseptic wound dehiscence with exposed endoprostheses may not necessitate prosthetic removal, arthrodesis, or amputation.
- This one-stage procedure offers a viable alternative, preventing infection and facilitating early mobilization.
- The findings suggest a potential paradigm shift in managing exposed endoprostheses, improving patient outcomes and reducing healthcare costs.