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Salvage procedures for complex soft tissue defects of the knee
M Y Nahabedian1, J C Orlando, R E Delanois
1Division of Plastic Surgery, Johns Hopkins University, Baltimore, MD, USA.
Clinical Orthopaedics and Related Research
|January 26, 1999
Summary
This study reviewed management for complex knee soft tissue defects, finding a 97% limb salvage rate. The protocol successfully avoided amputation in all 35 patients, preserving function and prostheses.
Area of Science:
- Orthopaedic Surgery
- Plastic Surgery
- Reconstructive Surgery
Background:
- Complex soft tissue defects around the knee present significant challenges, particularly when involving exposed joint prostheses or bone.
- Effective management is crucial to prevent limb loss and restore function.
Observation:
- A retrospective analysis of 35 patients (1986-1996) with complex knee defects was conducted.
- Treatment strategies were tailored based on wound characteristics: size, location, depth, and nature.
- Interventions included local wound care, debridement with skin grafting, and various flap techniques (fasciocutaneous, pedicled muscle, free muscle transfer).
Findings:
- The authors' management protocol achieved a 97% success rate in limb salvage (34 of 35 patients).
- Total knee prosthesis salvage was successful in 83% (24 of 29 patients).
- No amputations were required; however, secondary procedures (plastic surgery in 23%, orthopaedic surgery in 15%) were sometimes necessary.
Implications:
- This protocol demonstrates a high efficacy in managing severe knee soft tissue defects, significantly reducing amputation rates.
- It highlights the importance of a tailored, multidisciplinary approach for limb preservation and functional restoration.
- The findings support the use of advanced reconstructive techniques for complex peri-articular injuries.