1/22. Operative management and outcome of complex wounds following total knee arthroplasty.This study describes the treatment protocol for and the outcome of the management of complex wounds around total knee replacements. An analysis of 28 patients (29 knees) with complex defects who had surgery between January 1, 1986, and July 30, 1996, was performed. A specific management protocol was applied to each knee on the basis of the size and depth of the wound, the presence of infection, and the quality of soft tissue. Primary treatment included local wound care, debridement, and skin grafting or coverage with a fasciocutaneous flap, pedicled muscle flap, or free muscle transfer. Postoperatively, knees were evaluated using the Knee Society objective score. Successful salvage of the lower extremity was obtained in 28 knees (97 percent) and of the knee prosthesis in 24 of 29 knees (83 percent). Secondary plastic surgery procedures were necessary in five knees (17 percent), and secondary orthopedic procedures were necessary in four knees (14 percent). Successful salvage of total knee arthroplasty in the presence of a complex wound requires early identification of infection, aggressive irrigation and debridement, and early appropriate soft-tissue coverage. The use of our proposed algorithm will facilitate management of these complex wounds.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
2/22. Latissimus dorsi pedicle flap for coverage of soft tissue defects about the elbow.Sixteen consecutive patients who were treated with a pedicled latissimus dorsi flap for complex soft tissue defects about the elbow were reviewed. The average defect size was 100 cm2. Thirteen of the 16 patients achieved stable wound healing with a single procedure. Three patients had partial necrosis of the latissimus and required additional coverage procedures. We recommend that the latissimus dorsi flap should not be routinely used to cover defects more than 8 cm distal to the olecranon. The flap should be closely monitored in the first 48 hours, drains should be routinely used at the recipient and donor sites, and the elbow should be maintained in an extended position for the first 5 days after the procedure. The latissimus dorsi flap may also have a prophylactic role in selected patients with compromised soft tissue coverage about the elbow. The pedicled latissimus flap can be performed under loupe magnification and requires no microsurgical skills or equipment.- - - - - - - - - - ranking = 3keywords = soft (Clic here for more details about this article) |
3/22. vacuum-assisted wound closure: a new approach to spinal wounds with exposed hardware.STUDY DESIGN: The use of vacuum-assisted therapy to close upper thoracic and thoracolumbar spinal wounds was studied retrospectively. Two patients whose wounds failed conservative management were successfully treated by negative pressure therapy. OBJECTIVES: The authors evaluated the efficacy of applying vacuum therapy on patients with exposed spinal hardware and summarized current knowledge about this treatment. SUMMARY OF BACKGROUND DATA: vacuum therapy was applied three times on two patients. methods: Success was defined as a stable, closed wound that required no future surgery and had no signs of chronic infection. RESULTS: Both patients' wounds were closed successfully and have received follow-up treatment for up to 10 months with no sign of recurrence. CONCLUSIONS: The cases illustrate the usefulness of vacuum-assisted therapy as an adjunct in closing complex back wounds with exposed spinal hardware. In the authors' experience, it helps establish a soft tissue envelope for wound healing and simplifies the need for future surgery.- - - - - - - - - - ranking = 0.5keywords = soft (Clic here for more details about this article) |
4/22. Successful salvage of infected PTFE mesh after ventral hernia repair.Rates of hernia recurrence following repair of abdominal wall hernia defects have been shown to be lower when prosthetic biomaterials are used, but their presence may be associated with a higher rate of infectious complications. Traditional surgical teaching has advocated removal of contaminated or exposed prosthetics, although the morbidity of these revisions is high. The case presented involves a ventral hernia repair complicated by methicillin-resistant staphylococcus aureus infection and exposed polytetrafluoroethylene mesh. The open abdominal wound was successfully managed with a combination of intravenous antibiotics, local wound debridement, vacuum-assisted closure, and soft tissue coverage of the mesh. Eighteen months following surgical closure of the wound, no hernia recurrence or infection was evident.- - - - - - - - - - ranking = 0.5keywords = soft (Clic here for more details about this article) |
5/22. Bronchial myoplasty with the use of latissimus dorsi muscle--a case study.Dehiscence of the bronchial stump as well as the tracheo-bronchial-pleural fistula is a rare but life-threatening complication of pulmonary resections. Absence of the immediately accessible well vascularized soft tissues makes successful direct resuture of the bronchial stump or local closure of the defect problematic, particularly in the infected terrain. The authors describe a case study of successful closure of the tracheo-bronchial defect with the use of pediculated latissimus dorsi muscle in a cachectic 63-year-old patient after a right-side pneumonectomy.- - - - - - - - - - ranking = 0.5keywords = soft (Clic here for more details about this article) |
6/22. Functional total and subtotal heel reconstruction with free composite osteofasciocutaneous groin flaps of the deep circumflex iliac vessels.Functional and esthetic reconstruction of the bony and tendinous structures with a stable, sensate soft tissue integument after complex posttraumatic defects of the heel is demanding. Cases are rare in the literature and hardly comparable due to their heterogeneity. The reconstructive approach has to consider both patient profile and the reconstructive tree, with free microvascular flaps playing a primary role. The goals are the reconstruction of both osteotendinous structures and slender soft tissue lining for proper shoe fitting for ambulation and mechanical and thermal protection. The flap should be sensate in weightbearing areas to optimize gait and to prevent long-term complications by ulcers. The osteofasciocutaneous deep inferior circumflex artery (DCIA) flap is especially suitable for complex heel defects with subtotal or total loss of the calcaneal bone as all components (iliac bone, groin skin, and fascia lata) can have a wide range of size and shape. We operated on 2 cases with this variable composite flap. One patient had a complete heel defect by war shrapnel. The complete calcaneus, soft heel, and achilles tendon were reconstructed. The second patient had an empty os calcis after a comminuted fracture and a lateral crush-induced soft tissue defect. In both patients, a stable wound closure, osseous integration, and weightbearing ambulation could be achieved.- - - - - - - - - - ranking = 2keywords = soft (Clic here for more details about this article) |
7/22. Laparoscopic greater omentum harvesting with split-thickness skin grafting for sternal wound dehiscence.Sternal wound dehiscence is a serious complication occasionally requiring soft tissue coverage. The greater omentum typically has been used as a last resort because of the underlying morbidity from a laparotomy. We present a case in which a laparoscopically created omental flap with subsequent split-thickness skin grafting was used to correct a large soft tissue defect that occurred after sternal wound dehiscence developed. A nonambulatory 49-year-old man who underwent coronary artery bypass grafting developed sternal wound dehiscence. Because a large soft tissue defect developed after multiple debridements, soft tissue coverage was required. A laparoscopically harvested omental flap spared this man's upper extremity musculature and provided a soft tissue bed for split-thickness skin grafting. This case helps to establish the role of laparoscopically harvested omentum. If the results suggested by this case are confirmed in a large series, omental flaps should be considered as options of first choice in the management of sternal wound dehiscence.- - - - - - - - - - ranking = 2.5keywords = soft (Clic here for more details about this article) |
8/22. Intrathoracic xanthoma mimicking lung cancer in a patient with familial hypercholesterolemia type II: a case report.Xanthomas are benign soft-tissue lesions commonly occurring on the skin, subcutis, or tendon sheaths of patients. The lung and thoracic cavity is a rare location for xanthomas. We present a 39-year-old woman who was admitted to our hospital with complaints of dyspnea, cough, and chest pain. She had a prior diagnosis of type II familial hypercholesterolemia. Chest x-ray film and computed tomography scans revealed a large tumor-like mass in the right hemithorax. Thoracal mass and narrowed tracheal segments were removed using cardiopulmonary bypass. Histopathologic findings were consistent with xanthoma.- - - - - - - - - - ranking = 0.5keywords = soft (Clic here for more details about this article) |
9/22. Salvage of jeopardized total-knee prosthesis: the role of the gastrocnemius muscle flap.Total-knee arthroplasty has provided many patients with excellent long-term functional results. However, exposure of a total-knee replacement usually eventuates in failure. The relatively superficial location of the prosthesis, the need for early active motion, previous surgical incisions, and a variety of systemic factors may militate against early wound healing. Restoration of well-vascularized soft-tissue cover can salvage an otherwise disastrous situation. The authors recommend early operative intervention upon observation of wound breakdown, devitalized skin edges, or significant subcutaneous infection leading to necrotic overlying skin. The operative procedure found to salvage the majority of prostheses consists of adequate debridement, antibiotic irrigation (of the joint, if exposed), and coverage with a well-vascularized muscle flap, preferably the medial gastrocnemius muscle. The operative technique and ultimate long-term outcome are reviewed based on experience with 10 consecutive patients presenting with a jeopardized knee prosthesis. Follow-up ranged from 1 to 6 years. Representative case histories are presented.- - - - - - - - - - ranking = 0.5keywords = soft (Clic here for more details about this article) |
10/22. Muscle-flap coverage of exposed endoprostheses.A well-entrenched tenet in the orthopedic community is that dehiscent wounds overlying exposed endoprostheses should be treated by implant removal and delayed reconstruction. A new management protocol utilizing thorough soft-tissue debridement and myocutaneous or muscle-flap coverage was evaluated in four patients at the UCLA Medical Center who presented with exposed endoprostheses. These prostheses were placed for total-joint replacement or limb salvage surgery. All four prostheses and extremities were salvaged without the need for endoprosthesis removal or exchange, and no infections developed. The results suggest that late aseptic wound dehiscence with an exposed endoprosthesis need not be managed with prosthetic removal, arthrodesis, or amputation. This one-stage procedure avoided infection, allowed early mobilization, and shortened hospitalization.- - - - - - - - - - ranking = 0.5keywords = soft (Clic here for more details about this article) |
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