Simultaneous Infection Control and Reconstruction Using Continuous Local Antibiotic Perfusion in Septic Knee With Extensive Soft Tissue Defect: A Case Report

BACKGROUND Continuous local antibiotic perfusion (CLAP) has emerged as a treatment strategy for bone and soft tissue infections; however, its role in septic arthritis with extensive soft tissue defects remains unclear. We report a case of septic knee arthritis with joint exposure after patellar fracture fixation, in which a combined strategy of aggressive source control, CLAP, and early flap reconstruction enabled infection management and soft tissue coverage to proceed concurrently rather than sequentially. CASE REPORT A 69-year-old woman developed methicillin-resistant Staphylococcus aureus infection with a 12×8 cm anterior knee soft tissue defect after patellar fracture fixation, presenting 2.5 months after the index surgery. Total patellectomy, extensive debridement, and CLAP were performed. With CLAP maintained throughout, reconstruction with a gastrocnemius muscle flap and split-thickness skin grafting was performed 1 week later, allowing infection management and reconstruction to proceed in parallel. Soft tissue coverage was achieved 17 days after referral, and inflammatory markers normalized within 3 weeks. At the 2-year follow-up, there was no recurrence of infection, and the patient was able to ambulate with full weight-bearing using a knee extension orthosis and a cane. CONCLUSIONS In selected salvage cases, a combined strategy incorporating CLAP and early flap reconstruction may allow infection control and reconstruction to proceed in parallel. The contribution of individual components cannot be isolated from this single case. Although total patellectomy compromised the extensor mechanism, the outcome was clinically acceptable in the context of limb salvage and eradication of infection.