Vastus lateralis flaps for chronic recalcitrant hip infection
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1Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan, Republic of China.
Abstract:
Between January 1991 and May 1994, 11 patients with chronic recalcitrant infection of the hip joint were successfully treated by transposition of a vastus lateralis flap. The average duration of the infection was 7.9 months. The patients had undergone an average of 2.8 procedures in an attempt to eradicate the infection before transposition of the flap. Three patients had recurrence of drainage after the procedure and were successfully treated with antibiotics and local debridement. Delayed exchange total hip arthroplasty was performed in 2 patients. All the patients achieved wound healing and infection resolution. This flap has several advantages. The donor site has not usually been scarred from previous operations; the flap has a consistent vascular pedicle which permits a wide arc of rotation; knee extension is unaffected; the transposed portion of the vastus lateralis can act as a cushion between the acetabulum and the proximal femur; it may also act as a tether to prevent extreme proximal migration of the femur. In the management of chronic recalcitrant infection of the hip, use of a transposition flap can be combined with a Girdlestone arthroplasty. It can also be an interim procedure before a further total joint arthroplasty.
Insights
Vastus lateralis flap transposition effectively treated chronic hip joint infections in 11 patients, achieving wound healing and infection resolution. This surgical technique offers advantages for managing recalcitrant hip infections.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Management
- Reconstructive Surgery
Background:
- Chronic recalcitrant hip joint infections pose significant challenges in treatment.
- Previous surgical attempts to eradicate infection averaged 2.8 procedures per patient.
- The average duration of infection prior to flap transposition was 7.9 months.
Purpose of the Study:
- To evaluate the efficacy of vastus lateralis flap transposition for chronic recalcitrant hip joint infections.
- To assess the functional and infectious outcomes following this reconstructive procedure.
- To highlight the advantages of the vastus lateralis flap in hip infection management.
Main Methods:
- Retrospective analysis of 11 patients treated with vastus lateralis flap transposition between January 1991 and May 1994.
- Surgical procedure involved transposition of a vastus lateralis flap to the hip joint.
- Post-operative management included antibiotics and debridement for recurrent drainage in some cases.
Main Results:
- All 11 patients achieved wound healing and resolution of hip joint infection.
- Three patients experienced recurrent drainage, successfully managed with antibiotics and debridement.
- Two patients underwent delayed exchange total hip arthroplasty post-flap transposition.
Conclusions:
- Vastus lateralis flap transposition is a successful treatment for chronic recalcitrant hip joint infections.
- The flap provides a vascularized cushion, potentially preventing proximal femur migration.
- This technique can be combined with Girdlestone arthroplasty or serve as an interim procedure for future total joint arthroplasty.