scholarly journals Orthoplastics in Periprosthetic Joint Infection of the Knee: Treatment Concept for Composite Soft-tissue Defect with Extensor Apparatus Deficiency

2020 ◽  
Vol 5 (3) ◽  
pp. 160-171 ◽  
Author(s):  
Rik Osinga ◽  
Maurice Michel Eggimann ◽  
Steven John Lo ◽  
Richard Kühl ◽  
Alexander Lunger ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Soft Tissue Defect ◽  
Anterolateral Thigh Flap ◽  
Treatment Concept ◽  
Long Term Outcome ◽  
Tissue Defect ◽  
Extensor Apparatus

Abstract. Introduction: Reconstruction of composite soft-tissue defects with extensor apparatus deficiency in patients with periprosthetic joint infection (PJI) of the knee is challenging. We present a single-centre multidisciplinary orthoplastic treatment concept based on a retrospective outcome analysis over 20 years.Methods and Results: One-hundred sixty patients had PJI after total knee arthroplasty. Plastic surgical reconstruction of a concomitant perigenicular soft-tissue defect was indicated in 47 patients. Of these, six presented with extensor apparatus deficiency. One patient underwent primary arthrodesis and five patients underwent reconstruction of the extensor apparatus. The principle to reconstruct missing tissue 'like with like' was thereby favoured: Two patients with a wide soft-tissue defect received a free anterolateral thigh flap with fascia lata; one patient with a smaller soft-tissue defect received a free sensate, extended lateral arm flap with triceps tendon; and two patients who did not qualify for free flap surgery received a pedicled medial sural artery perforator gastrocnemius flap. Despite good functional results 1 year later, long-term follow-up revealed that two patients had to undergo arthrodesis because of recurrent infection and one patient was lost to follow-up.Conclusion: These results show that PJI of the knee and extensor apparatus deficiency is a dreaded combination with a poor long-term outcome. Standardization of surgical techniques for a defined PJI problem and consensus on study variables may facilitate interinstitutional comparisons of outcome data, and hence, improvement of treatment concepts.

scholarly journals A case series of flow-through free anterolateral thigh flap to augment the vascularity of ischaemic limbs with soft tissue defect

2016 ◽  
Vol 49 (01) ◽  
pp. 35-41 ◽  
Author(s):  
Aditya Aggarwal ◽  
Hardeep Singh ◽  
Sanjay Mahendru ◽  
Vimalendu Brajesh ◽  
Sukhdeep Singh ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Limb Salvage ◽  
Soft Tissue Defect ◽  
Single Step ◽  
Anterolateral Thigh Flap ◽  
Vascular Repair ◽  
Tissue Defect ◽  
Soft Tissue Cover ◽  
Anterolateral Thigh ◽  
Flow Through

ABSTRACT Introduction: In a world of fast moving vehicles, heavy machinery and industries crush injury to limbs with vascular compromise and soft tissue defect is common. The traditional treatment is a 2 step one dealing with vascular repair and soft tissue cover separately, in the same operation. We report a series of single step vascular repair and soft tissue cover with flow through anterolateral thigh flap (ALT) flap for limb salvage. Materials and Methods: Ten patients with soft tissue defect and vascular injury were included in this study. A two team approach was used to minimise operative time, team one prepared the vessels and team 2 harvested the flap. Observations and Results: Of the ten patients operated (8 males), eight flaps were done for upper limb and two for lower limb salvage. Six anastomosis were done with ulnar vessels, two with radial and two with posterior tibial vessels. Nine extremities could be salvaged while one patient developed progressive thrombosis leading to amputation. Conclusion: The ALT flow-through flap is a versatile single step procedure that can be used to salvage an ischemic limb with soft tissue loss avoiding the need for interpositional vein graft.

Long Term Outcomes of Total Knee Arthroplasty Following Soft Tissue Defect Reconstruction with Flaps

2015 ◽  
Vol 136 ◽  
pp. 15-16
Author(s):  
Grzegorz Kwiecien ◽  
Gregory Lamaris ◽  
Bahar Bassiri Gharb ◽  
Trevor Murray ◽  
Mark F. Hendrickson ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Soft Tissue Defect ◽  
Long Term Outcomes ◽  
Tissue Defect ◽  
Defect Reconstruction ◽  
Total Knee

Long-Term Outcomes of Total Knee Arthroplasty following Soft-Tissue Defect Reconstruction with Muscle and Fasciocutaneous Flaps

2016 ◽  
Vol 137 (1) ◽  
pp. 177e-186e ◽  
Author(s):  
Grzegorz J. Kwiecien ◽  
Gregory Lamaris ◽  
Bahar Bassiri Gharb ◽  
Trevor Murray ◽  
Mark F. Hendrickson ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Soft Tissue Defect ◽  
Long Term Outcomes ◽  
Fasciocutaneous Flaps ◽  
Tissue Defect ◽  
Defect Reconstruction ◽  
Total Knee

scholarly journals Reconstruction of Soft-Tissue Defect Around the Knee Using a Pedicled Reverse-Flow Anterolateral Thigh Flap: A Case Report

2020 ◽  
Vol 25 (1) ◽  
pp. 55-59
Author(s):  
Nam Jang ◽  
Hyun Woo Shin ◽  
Kun Chul Yoon
Keyword(s):  
Soft Tissue ◽  
Reverse Flow ◽  
Soft Tissue Defect ◽  
Anterolateral Thigh Flap ◽  
Tissue Defect ◽  
Circumflex Femoral Artery ◽  
Anterolateral Thigh ◽  
Pedicle Length ◽  
Lateral Circumflex Femoral ◽  
Alt Flap

Coverage of traumatic soft-tissue defects around the knee is a challenging problem for reconstructive surgeons though many reconstructive options are available. We planned to use a pedicled reverse-flow anterolateral thigh (ALT) flap using the distal branch of the descending branch of the lateral circumflex femoral artery (LCFA) for pedicle length extension in a patient with the ALT perforator branch originating from the proximal portion of the descending branch of LCFA. We present the successful use of a pedicled reverse-flow ALT flap to cover a soft tissue defect around the knee.

scholarly journals Fungal necrotizing fasciitis of face- a reconstructive challenge

2021 ◽  
Vol 9 (2) ◽  
pp. 632
Author(s):  
Deepti Gupta ◽  
Sujata Sarabahi ◽  
Ananda Murthy K. T. ◽  
Nupur Aggarwal
Keyword(s):  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Soft Tissue Defect ◽  
Liposomal Amphotericin B ◽  
Anterolateral Thigh Flap ◽  
Tissue Defect ◽  
The Face ◽  
The Right

Fungal necrotizing fasciitis (NF), particularly in the face, is an unusual infection. It is mostly seen in immunocompromised individuals and can be gravely destructive if diagnosis and treatment are delayed. We report this rare case of a 27-year-old, immunocompetent male who presented with gangrenous patch of skin on the cheek following blunt trauma to the right side of the face. Till now no case has been reported in literature with such an extensive soft tissue loss of face and involvement of facial skeleton due to fungal etiology. Clinical suspicion of necrotizing fasciitis led to early surgical intervention. Histopathological examination of the debrided tissue identified the infective organism as Apophysomyces elegans. Intravenous antifungal therapy with liposomal amphotericin B was initiated. Despite the prompt commencement of the treatment, the infection continued to spread, and the patient had to undergo serial debridement which resulted in orbital exenteration, partial maxillectomy and mandibulectomy on the right side. This resulted in a huge soft tissue defect requiring flap cover. A free anterolateral thigh flap was harvested to cover the soft tissue defect, but the blood flow could not be established. For salvage, scalp and pectoralis major muscle flaps were raised and used to cover the large hemifacial defect. The oral lining was created with a folded deltopectoral flap in a second stage. However, there was persistence of the fungal elements in wound bed even after prolonged systemic liposomal amphotericin B therapy and it invaded the flap margins due to which there was partial necrosis of the flap. In this article, we aim to describe the difficulties faced by us in the management of such devastating infection and the reconstructive challenge that it posed.  

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