Abstract
In bone infections, it is of fundamental importance to wrap any orthopaedic surgical procedure in healthy vascularised soft tissue, in order to allow good healing and to prevent infection recurrence.
Vitality of soft tissues around the knee joint can be easily jeopardized in patients undergoing multiple surgical operations as in case of infected arthroprostheses. In addition, there are very few local options in the soft tissue reconstruction of this area, due to the fact that the vascularisation of skin and subcutaneous tissue is based on the genicular arteries’ axes which prohibits the use of random skin flaps.
Preoperative planning of cutaneous incisions and reconstructive procedures is mandatory for a correct surgical treatment.
We analyze retrospectively a series of 8 patients who underwent soft tissue reconstruction of the knee area with local flaps, considering criteria and indications in the choice of each surgical option.
Main variables considered in decision-making were size and location of soft tissue defect, planned orthopaedic surgical procedure, likeliness of the need for further surgery, age, local and general condition of the patient.
Flaps employed have been medial gastrocnemius muscular flap, reverse ALT fasciocutaneous flap and the “propeller” freestyle perforator flap.
Main complications observed have been partial flap necroses and recurrence of the underlying bone infection.
In this work, the authors want to emphasize the importance of a multidisciplinary treatment of bone and prosthetic infections, where the antimicrobial therapy chosen by the Infectious Diseases Specialist must be synergic with an “orthoplastic” surgical procedure, in the effort to reduce the risk of infection persistence or recurrence and to obtain the best possible functional result and quality of life for the patient.
Correspondence should be addressed to Vienna Medical Academy, Alser Strasse 4, A-1090 Vienna, Austria. Phone: +43 1 4051383 0, Fax: +43 1 4078274, Email: ebjis2009@medacad.org
