Clinical Outcome of Free Latissimus Dorsi Flaps for Coverage of Soft Tissue Defects in Multiply Revised Total Knee Arthroplasties
| Autor: | Jonathan Miles, James Donaldson, Abtin Alvand, Antony C. Raymond, Richard Carrington, Alexander D. Liddle |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Free flap Surgical Flaps 03 medical and health sciences 0302 clinical medicine medicine Humans Orthopedics and Sports Medicine Arthroplasty Replacement Knee Aged Retrospective Studies 030222 orthopedics business.industry Soft tissue Retrospective cohort study Plastic Surgery Procedures Arthroplasty Confidence interval Surgery Treatment Outcome Amputation Superficial Back Muscles Female Implant business Oxford knee score |
| Zdroj: | The Journal of Arthroplasty. 36:664-669 |
| ISSN: | 0883-5403 |
| Popis: | Background Multiply revised total knee arthroplasties (TKAs) may present with large anterior soft tissue defects, which can be challenging to reconstruct. In the rare cases where local flaps are insufficient, we use free latissimus dorsi (LD) myocutaneous flaps to achieve soft tissue coverage. This study looked to determine implant survivorship, infection status, and patient-reported outcomes of patients undergoing simultaneous revision TKA and LD flaps in a tertiary unit. Methods This was a retrospective study of 18 consecutive patients who had revision TKA and free LD flap reconstruction. Twelve were male and the median age was 65 years (range, 35-83). Patients had undergone a median of 4 previous arthroplasty procedures (range, 3-6). Median follow-up was 49 months (range, 18 to 110). The primary outcome was revision-free implant survival. Secondary outcomes included soft tissue integrity, Oxford Knee Score, and EuroQol 5-domain score at latest follow-up. Results At latest follow-up, 14 of 18 patients had maintained their implant. Seven patients were infection-free, 7 were on suppressive antibiotics with the implant in situ, and 4 had undergone above-knee amputation. Five-year implant survival was 75% (95% confidence interval, 46-90). At median follow-up (49 months), mean Oxford Knee Score was 13.4 (range, 2-35) and mean EuroQol 5-domain index was 0.071 (range:−0.427 to 0.747). Conclusion LD free flap is a viable option for limb salvage in patients with large anterior soft tissue defects following multiple revisions of TKA. However, functional outcomes can be poor and there is a significant risk of ongoing infection and amputation in this complex patient cohort. |
| Databáze: | OpenAIRE |
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