MANAGEMENT OF SKIN NECROSIS AROUND INCISION FOLLOWING TOTAL KNEE ARTHROPLASTY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 SHENYuming ¹ , HANDong ² , QINFengjun ¹

1. Department of Burns, Beijing Jishuitan Hospital, Beijing, 100035, P. R. China;
2. Department of Burns, Daqing Longnan Hospital;

Corresponding?author：

SHENYuming, Email: shenyuming1963@163.com

Keywords：

Total knee arthroplasty; Skin necrosis; Flap; Repair

DOI：

10.7507/1002-1892.20140217

Video：

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Objective To investigate the risk factors of skin necrosis around incision after total knee arthroplasty (TKA),and explore the measures of prevention and treatment. Methods Between June 2007 and June 2013,7 patients with skin necrosis around incision after TKA were treated.There were 5 males and 2 females with an average age of 69 years (range,59-78 years),including osteoarthritis in 4 cases,traumatic arthritis in 2 cases,and rheumatoid arthritis in 1 case.Two cases complicated by diabetes,and 2 cases by hypertension; 1 case received long-term hormone therapy; and 2 cases had a history of smoking.Scar was seen near knee joint in 2 cases.The skin necrosis ranged from 10 cm×2 cm to 13 cm×8 cm.The time from TKA to debridement was 7-15 days (mean,12 days).After thorough debridement,the saphenous artery skin flap,medial head of gastrocnemius muscle flap,lateral head of gastrocnemius muscle flap were used in 4 cases,2 cases,and 1 case respectively; reconstruction of patellar ligament was performed in 2 cases.Donor sites were repaired by split-thickness skin graft. Results All the flaps and myocutaneous flaps survived well,and all wounds healed by first intention.At donor site,the grafted skins survived and wounds healed by first intention.No early complication occurred.All cases were followed up 6-12 months (mean,7.8 months).The flaps and myocutaneous flaps had good texture and appearance; no prosthetic loosening and displacement happened,no secondary infection was observed after operation.The knee range of motion was 45-110° (mean,85°) at 6 months after operation.According to the Knee Society Score (KSS),the results were excellent in 3 cases,good in 2 cases,general in 1 case,and poor in 1 case at 6 months after operation. Conclusion Early discovery,thoroughly debridement,and timely repair with axial pattern flap or myocutaneous flap are the key factors to treat skin necrosis around incision after TKA and save the artificial prosthesis.

Citation： SHENYuming, HANDong, QINFengjun. MANAGEMENT OF SKIN NECROSIS AROUND INCISION FOLLOWING TOTAL KNEE ARTHROPLASTY. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(8): 985-987. doi: 10.7507/1002-1892.20140217 Copy

1.	Vince KG,Abdeen A.Wound problems in total knee arthroplasty.Clin Orthop Relat Res,2006,(452):88-90.
2.	高增鑫,邱貴興,翁習生,等.全膝關節置換術后切口周圍皮緣壞死的原因分析.中華外科雜志,2008,46(9):664-666.
3.	成亮,李康華.全膝關節置換術后并發癥的現狀與進展.中華關節外科雜志(電子版),2013,7(2):83-85.
4.	朱振安.規范化治療預防全膝關節置換術后并發癥.中華關節外科雜志(電子版),2008,2(6):1-2.
5.	Galat DD,McGovern SC,Larson DR,et al.Surgical treatment of early wound complications following primary total knee arthroplasty.J Bone Joint Surg (Am),2009,91(1):48-54.
6.	Panni AS,Vasso M,Cerciello S,et al.Wound complications in total knee arthroplasty.Which flap is to be used? With or without retention of prosthesis? Knee Surg Sports Traumatol Arthrosc,2011,19(7):1060-1068.
7.	陳昌偉,錢齊榮,吳海山,等.全膝關節置換術后感染的傷口處理.中華關節外科雜志(電子版),2008,2(6):59-61.
8.	Ries MD.Skin necrosis after total knee arthroplasty.J Arthroplasty,2002,17(4 Suppl 1):74-77.
9.	Ries MD,Bozic K.Medial gastrocnemius flap coverage for treatment of skin necrosis after total knee arthroplasty.Clin Orthop Relat Res,2006,446(2):186-192.
10.	劉忠堂,柴益民,張先龍,等.全膝關節置換術后皮膚壞死的處理.中華關節外科雜志(電子版),2012,6(6):9-11.
11.	Vince K,Chivas FD,Droll KP.Wound complications after total knee arthroplasty.J Arthroplasty,2007,22 (4 Suppl 1):39-44.
12.	Andres LA,Casey WJ,Clarke HD.Techniques in soft tissue coverage around the knee.Tech Knee Surg,2009,8(2):119-125.
13.	Casanova D,Hulard O,Zalta R,et al.Management of wounds of exposed or infected knee prostheses.Scand J Plast Reconstr Surg Hand Surg,2001,35(1):71-77.
14.	楊紹浦,周丕育,周健,等.隱動脈皮瓣的臨床應用.中華整形外科雜志,2014,30(2):138-139.
15.	李浩,梅勁,季衛平,等.膝降動脈隱支皮瓣游離移植修復手部軟組織缺損.中華顯微外科雜志,2012,35(2):97-99.
16.	湯鋒,王海軍,肖杰,等.腓腸肌內側頭肌皮瓣修復膝關節深度創面的觀察.中華臨床醫師雜志(電子版),2012,6(17):5338-5339.
17.	Busfield BT,Huffman GR,Nahai F,et al.Extended medial gastrocnemius rotational flap for treatment of chronic knee extensor mechanism deficiency in patients with and without total knee arthroplasty.Clin Orthop Relat Res,2004,(428):190-197.
18.	Warrier SK,Mah E,Morrison WA.Extended medial gastrocnemius myocutaneous flap in repair of the quadriceps extension mechanism.ANZ J Surg,2006,76(12):1110-1114.

1. Vince KG,Abdeen A.Wound problems in total knee arthroplasty.Clin Orthop Relat Res,2006,(452):88-90.
2. 高增鑫,邱貴興,翁習生,等.全膝關節置換術后切口周圍皮緣壞死的原因分析.中華外科雜志,2008,46(9):664-666.
3. 成亮,李康華.全膝關節置換術后并發癥的現狀與進展.中華關節外科雜志(電子版),2013,7(2):83-85.
4. 朱振安.規范化治療預防全膝關節置換術后并發癥.中華關節外科雜志(電子版),2008,2(6):1-2.
5. Galat DD,McGovern SC,Larson DR,et al.Surgical treatment of early wound complications following primary total knee arthroplasty.J Bone Joint Surg (Am),2009,91(1):48-54.
6. Panni AS,Vasso M,Cerciello S,et al.Wound complications in total knee arthroplasty.Which flap is to be used? With or without retention of prosthesis? Knee Surg Sports Traumatol Arthrosc,2011,19(7):1060-1068.
7. 陳昌偉,錢齊榮,吳海山,等.全膝關節置換術后感染的傷口處理.中華關節外科雜志(電子版),2008,2(6):59-61.
8. Ries MD.Skin necrosis after total knee arthroplasty.J Arthroplasty,2002,17(4 Suppl 1):74-77.
9. Ries MD,Bozic K.Medial gastrocnemius flap coverage for treatment of skin necrosis after total knee arthroplasty.Clin Orthop Relat Res,2006,446(2):186-192.
10. 劉忠堂,柴益民,張先龍,等.全膝關節置換術后皮膚壞死的處理.中華關節外科雜志(電子版),2012,6(6):9-11.
11. Vince K,Chivas FD,Droll KP.Wound complications after total knee arthroplasty.J Arthroplasty,2007,22 (4 Suppl 1):39-44.
12. Andres LA,Casey WJ,Clarke HD.Techniques in soft tissue coverage around the knee.Tech Knee Surg,2009,8(2):119-125.
13. Casanova D,Hulard O,Zalta R,et al.Management of wounds of exposed or infected knee prostheses.Scand J Plast Reconstr Surg Hand Surg,2001,35(1):71-77.
14. 楊紹浦,周丕育,周健,等.隱動脈皮瓣的臨床應用.中華整形外科雜志,2014,30(2):138-139.
15. 李浩,梅勁,季衛平,等.膝降動脈隱支皮瓣游離移植修復手部軟組織缺損.中華顯微外科雜志,2012,35(2):97-99.
16. 湯鋒,王海軍,肖杰,等.腓腸肌內側頭肌皮瓣修復膝關節深度創面的觀察.中華臨床醫師雜志(電子版),2012,6(17):5338-5339.
17. Busfield BT,Huffman GR,Nahai F,et al.Extended medial gastrocnemius rotational flap for treatment of chronic knee extensor mechanism deficiency in patients with and without total knee arthroplasty.Clin Orthop Relat Res,2004,(428):190-197.
18. Warrier SK,Mah E,Morrison WA.Extended medial gastrocnemius myocutaneous flap in repair of the quadriceps extension mechanism.ANZ J Surg,2006,76(12):1110-1114.

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MANAGEMENT OF SKIN NECROSIS AROUND INCISION FOLLOWING TOTAL KNEE ARTHROPLASTY

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