Abstract
Background
Infection is one of the most severe comlications of the total arthroplasty. We sometimes encounter cases, which are very hard to finish repeated recurrence. Usage of steroids, immunosuppressants, and biologics would possibly effect to the incidence of the prosthetic infection and to the result of its treatment. Biologics have drastically decreased the number of the total arthoplasic patients, on the other hand, we must be more careful about the infectious conditions. For the infection two stage revision surgery; first removal and antibiotics cement spacer insertion then reimplantation later; is often chosen but sometimes one time antibiotics cement spacer cannot stop the infection and requires multi times spacer insertion. In those cases the dead spaces, poor blood supply and tight skin could be the cause of the recurrence. For these cases we had been performing musclo-cutaneal flap and successfully finish the infection.
Objectives
Our objectives are to review infection cases treated with musclo-cutaneal flap and compare with treatment without it. Methods: Since 2004 to 2013, 6 infection cases were treated. Our standard policy is 2-staged revision. In the first surgery, the prosthesis was removed and cement spacer was inserted. If no evidence of the remained infection was found reimplantation would be done in the second surgery. Otherwise debridement and cement spacer were repeated. In 3 cases, the infection could be finished without musclo-cutaneal flap but in 3 cases musclo-cutaneal flap was finally done then the infection was finished. The clinical courses were reviewed.
Results
Case 1. After right hip revision, fistula formation was occurred. Later, enterococcus fecalis was detected. Six times cement spacer insertion was performed. But fistula was remained. Musclo-cutaneal flap of sartorius muscle was performed. No fistula was seen after that. Case 2. Fistula was appeared 3 years after hip replacement. The culture was negative. New prosthesis insertion was done after one time spacer treatment then the infection was controlled. Case 3. Six weeks after primary hip replacement, fistula was appeared. MRSA was found. Three times antibiotic spacer insertions were done then re-implantation was successfully done. Case 4. Three weeks after total knee replacement, the wound became lose and MRSA was found. The wound was communicated with the joint and the patient had general weakness, so musclo-cutaneal flap was done in one time. No recurrence was seen. Case 5. Two weeks after total hip replacement, MRSA superficial infection was found. Wound washing and both injection and oral antibiotics were used. Case 6. This patient was sent from a certain hospital after 3 times open debridement. MRSA was still positive. One time antibiotics spacer was done, and then revision with musculo-cutaneal flap of lateral vastus muscle was performed. No recurrence is seen so far. In all flap cases, infection was finished in our case. On the other hand, the surgical invasion was much bigger. So we can take musculo cutaneal flap into consideration to overcome the recurent infection.
