Complex Reconstruction of the Knee with a Free Vertical Rectus Abdominis Flap after Periprosthetic Soft Tissue Necrosis

Periprosthetic joint infection (PJI) is limb threatening and difficult to treat. Although a two-stage re-implantation is accepted as the standard of care for PJI, extensive debridement, numerous surgeries, or liquifactive necrosis from the infection can result in a tissue defect. With a large tissue...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2019-01, Vol.11 (1), p.e3969
Main Authors: Perrault, David, Manrique, Oscar J, Lee, Gene, Carre, Antione L, Oakes, Daniel A, Wong, Alex K
Format: Article
Language:English
Subjects:
Case reports
Defects
Infections
Infectious Disease
Joint surgery
Knee
Necrosis
Orthopedics
Plastic Surgery
Prostheses
Skin & tissue grafts
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Summary:Periprosthetic joint infection (PJI) is limb threatening and difficult to treat. Although a two-stage re-implantation is accepted as the standard of care for PJI, extensive debridement, numerous surgeries, or liquifactive necrosis from the infection can result in a tissue defect. With a large tissue defect, soft tissue coverage is required to protect the prosthesis, fill any dead space, and obtain a satisfactory wound closure. With defects too large for local or regional flap coverage, free tissue transfer is the best option. We present a case in which soft tissue coverage with both medial and lateral gastrocnemius muscle flaps was not sufficient; free tissue transfer was necessary for both wound closure and creation of an adequate soft tissue envelope for the future placement of a prosthesis. Regardless of the complicated surgical history and extensive soft tissue damage, limb function was restored and the patient regained his independence.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.3969