PDF(Pubmed)
Abstract：
UNASSIGNED: Periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) presents significant challenges, especially in elderly and comorbid patients, often necessitating revision surgeries. We report on a series of patients with confirmed PJI of the knee and concomitant soft-tissue/extensor apparatus defects, treated by using pedicled myocutaneous medial or lateral sural artery perforator (MSAP/LSAP) gastrocnemius flaps.
UNASSIGNED: Our retrospective study at the Center for Musculoskeletal Infections, included patients with knee PJI undergoing pedicled myocutaneous MSAP/LSAP gastrocnemius flap reconstruction for combined soft tissue and extensor apparatus defects. The tendinous back of the gastrocnemius muscle was used and, if required, the Achilles tendon for extensor apparatus reconstruction, with the skin island addressing the cutaneous defect. Perioperative complications and postoperative outcomes after 1 year were evaluated, including functional and clinical assessments with the American Knee Society Score (AKSS).
UNASSIGNED: Eight patients (mean age 73 years; five female) were included, predominantly with Staphylococcus aureus infections. Six patients involved isolated MSAP flaps, two were extended with the Achilles tendon. The median time for wound healing was 9 days. Short-term follow-up showed successful reconstruction in seven patients, with minor wound dehiscence in one patient. One patient required flap revision for a perigenicular haemato-seroma and two patients were diagnosed with new haematogenous PJI infection. Significant improvement in AKSS scores after surgery was observed (functional AKSS: median 33-85; clinical AKSS: median 64-91, p = 0.001).
UNASSIGNED: Pedicled myocutaneous MSAP/LSAP gastrocnemius flaps offer a safe, reliable and versatile option for reconstructing combined soft tissue and extensor apparatus defects in PJI after TKA. This approach yields excellent functional outcomes with minimal peri- and postoperative complications, which is particularly beneficial in elderly and comorbid patients and feasible in settings without microsurgical availability.
UNASSIGNED: Level IV.
UNASSIGNED: Our retrospective study at the Center for Musculoskeletal Infections, included patients with knee PJI undergoing pedicled myocutaneous MSAP/LSAP gastrocnemius flap reconstruction for combined soft tissue and extensor apparatus defects. The tendinous back of the gastrocnemius muscle was used and, if required, the Achilles tendon for extensor apparatus reconstruction, with the skin island addressing the cutaneous defect. Perioperative complications and postoperative outcomes after 1 year were evaluated, including functional and clinical assessments with the American Knee Society Score (AKSS).
UNASSIGNED: Eight patients (mean age 73 years; five female) were included, predominantly with Staphylococcus aureus infections. Six patients involved isolated MSAP flaps, two were extended with the Achilles tendon. The median time for wound healing was 9 days. Short-term follow-up showed successful reconstruction in seven patients, with minor wound dehiscence in one patient. One patient required flap revision for a perigenicular haemato-seroma and two patients were diagnosed with new haematogenous PJI infection. Significant improvement in AKSS scores after surgery was observed (functional AKSS: median 33-85; clinical AKSS: median 64-91, p = 0.001).
UNASSIGNED: Pedicled myocutaneous MSAP/LSAP gastrocnemius flaps offer a safe, reliable and versatile option for reconstructing combined soft tissue and extensor apparatus defects in PJI after TKA. This approach yields excellent functional outcomes with minimal peri- and postoperative complications, which is particularly beneficial in elderly and comorbid patients and feasible in settings without microsurgical availability.
UNASSIGNED: Level IV.
摘要：
■全膝关节置换术（TKA）后假体周围感染（PJI）提出了重大挑战，尤其是老年和合并症患者，经常需要修正手术。我们报告了一系列确认为膝关节PJI并伴有软组织/伸肌设备缺损的患者，通过使用带蒂肌皮内侧或外侧腓肠动脉穿支（MSAP/LSAP）腓肠肌皮瓣治疗。
■我们在肌肉骨骼感染中心的回顾性研究，包括接受带蒂肌皮瓣MSAP/LSAP腓肠肌皮瓣重建治疗软组织和伸肌器官联合缺损的膝关节PJI患者。使用腓肠肌的肌腱背部，如果需要,用于伸肌重建的跟腱，用皮肤岛解决皮肤缺陷。术后1年评估围手术期并发症和术后预后,包括美国膝关节学会评分（AKSS）的功能和临床评估。
■包括8名患者（平均年龄73岁；5名女性），主要伴有金黄色葡萄球菌感染。六名患者涉及孤立的MSAP皮瓣，两个跟腱延长。伤口愈合的中位时间为9天。短期随访显示7例患者重建成功,一名患者有轻微的伤口裂开。一名患者需要进行皮瓣翻修以治疗周围的血源性血清肿，两名患者被诊断为新的血源性PJI感染。术后AKSS评分显著改善(功能性AKSS:中位数33-85;临床AKSS:中位数64-91,p=0.001)。
■带蒂肌皮肤MSAP/LSAP腓肠肌皮瓣提供了一种安全的，TKA后PJI重建软组织和伸肌器械联合缺损的可靠和通用的选择。这种方法可以产生出色的功能结果，并且围手术期和术后并发症最少。这对老年和合并症患者特别有益，在没有显微外科手术的情况下也是可行的。
■四级。
■我们在肌肉骨骼感染中心的回顾性研究，包括接受带蒂肌皮瓣MSAP/LSAP腓肠肌皮瓣重建治疗软组织和伸肌器官联合缺损的膝关节PJI患者。使用腓肠肌的肌腱背部，如果需要,用于伸肌重建的跟腱，用皮肤岛解决皮肤缺陷。术后1年评估围手术期并发症和术后预后,包括美国膝关节学会评分（AKSS）的功能和临床评估。
■包括8名患者（平均年龄73岁；5名女性），主要伴有金黄色葡萄球菌感染。六名患者涉及孤立的MSAP皮瓣，两个跟腱延长。伤口愈合的中位时间为9天。短期随访显示7例患者重建成功,一名患者有轻微的伤口裂开。一名患者需要进行皮瓣翻修以治疗周围的血源性血清肿，两名患者被诊断为新的血源性PJI感染。术后AKSS评分显著改善(功能性AKSS:中位数33-85;临床AKSS:中位数64-91,p=0.001)。
■带蒂肌皮肤MSAP/LSAP腓肠肌皮瓣提供了一种安全的，TKA后PJI重建软组织和伸肌器械联合缺损的可靠和通用的选择。这种方法可以产生出色的功能结果，并且围手术期和术后并发症最少。这对老年和合并症患者特别有益，在没有显微外科手术的情况下也是可行的。
■四级。
