Skin Necrosis after Total Knee Arthroplasty Treated with Eschar Preservation and Prophylactic Antibiotic Measures: A...

Skin necrosis following total knee arthroplasty (TKA) represents a rare, but serious complication that can lead to deep infection. In the setting of a lateral release performed during TKA, the incised retinaculum unveils a potential pathway to the joint should the superficial skin and tissue be compromised. Thus, the conventional treatment of debridement in this setting may risk infection to the joint, whereas eschar preservation may serve as a biological protective barrier to prevent infection.

We present a patient with end-stage tricompartmental knee osteoarthritis who underwent a TKA with a concomitant lateral release. The patient developed necrosis in two distinct areas measuring 14 cm × 2 cm along the length of the primary TKA incision, and 7 cm × 4 cm laterally. The patient was treated with eschar preservation, oral doxycycline, an antimicrobial silver dressing, and allowed to heal by secondary intention. The patient's skin necrosis healed fully at 12-week post-operatively, and they have had a successful TKA outcome at 5 years.

Eschar preservation, oral doxycycline, an antimicrobial silver dressing, and allowing the wound to heal by secondary intention may represent a viable, less invasive treatment for skin necrosis following TKA with lateral release.