Acute soft tissue defects (wound dehiscence or necrosis) after a total knee arthroplasty (TKA) may be the cause of the devasting complication of deep infection. When a medium (4–6cm) defect is present, in patellar or infra-patellar localization, a medial hemi-gastrocnemius flap is widely used to cover it, because of its low morbidity and high functional results. Normally, this coverage is not associated to a debridement, antibiotics and implant retention surgery (DAIR). When facing this situation, we should consider associating to the coverage treatment, like muscle flap, a DAIR procedure, in order to treat the possible acute infection, even when the diagnosis of infection is not clear. We could not find any studies comparing the benefice of this association in the same surgical act to isolated treatment of soft tissue defects. Our hypothesis was that when a TKA surgical wound defect is present, the risk of an acute infection is elevated and the patient would benefit from a muscle flap with DAIR procedure and polyethylene exchange. We performed a retrospective study to compare TKA infection clearance in patients with DAIR and flap in the same surgical act against those who received an isolated flap procedure for soft tissue coverage after an acute surgical wound defect. Patients were identified from a prospectively collated TKA database. Between 2005 and 2021, 19 patients met our inclusion criteria. A medial hemi-gastrocnemius flap was performed in 15 patients (78%). Healing or TKA infection clearance was defined as the presence of the original prosthesis after soft tissue coverage intervention, no need of DAIR after soft tissue coverage or no suppressive antibiotic treatment.Background
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