Τhe role of the gastrocnemius muscle flap in the treatment of failed Total Knee Arthroplasty.
Keywords:
Total knee arthroplasty, infection, surgery, failure, muscle flaps, gastrocnemius muscle, reconstruction.Abstract
ntroduction: Total knee arthroplasty (TKA), although generally a safe operation, fails in a small number of patients with substantial morbidity. Muscle flaps and especially the medial gastrocnemius offer a viable treatment option for limb salvage. The surgical technique is described and the senior author’s personal experience is reviewed.
Patients and methods: A retrospective study of patients treated with a medial gastrocnemius flap for failed TKA was conducted. Five patients were found, 4 female and one male. Mean age was 63.8 years (range, 38 – 85 years). Four patients were operated at the Middlesex and UCH Hospitals, London and one at Metropolitan General Hospital, Athens. All patients had a preexisting skin defect of the knee area with exposed tendon, bone and/or implant. The surgical technique used is briefly described. Postoperative antibiotics were administered to all patients for a minimum of 6 weeks.
Results: There were no flap or donor site complications. All flaps and skin grafts survived. One patient died at home five weeks postoperatively of unrelated causes. One patient presented with a wound breakdown three weeks after the flap operation. The defect was covered with a lateral tibial fasciocutaneous flap. The Oxford Knee Score improved in all patients.
Conclusion: The medial gastrocnemius muscle flap remains the first line of treatment of failed total knee arthroplasties. Early use of the flap is recommended in order to achieve the best possible outcome.
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