Die plastische Versorgung von Weichteildefekten nach Endoprothetik an der unteren Extremität

Abstract

The implantation of endoprostheses is an established procedure in orthopaedic and trauma surgery. However, the techniques are often associated with a high risk of post-interventional infections and wound healing disorders that can result in loss of the prosthesis or the limb--most likely based on an insufficient debridement and poor soft-tissue coverage. The purpose of this study was to evaluate the efficacy of the coverage methods in our patient population. In the past 10 years 38 patients with exposed knee prostheses and 14 patients following an ankle endoprosthesis were included in this retrospective study over the period from 2001 to 2011. Soft-tissue reconstructions around the knee were mostly performed by unilateral or bilateral gastrocnemius flaps combined with split-skin grafts. One defect was covered with a free flap. 57% of the soft-tissue defects around the ankle are often problematic and were closed by a pedicled peroneus brevis muscle flap and 35% by a free flap (3 with a latissimus dorsi muscle flap, 2 with a free lateral upper arm flap and one with an anterolateral tight flap). In our patient population we achieved stable soft-tissue coverage in most of the cases using the above-mentioned flaps. Due to multiple preexisting comorbidities, it was observed that the course was frequently prolonged and wound healing difficulties occurred. These, however, could be controlled by conservative means or small secondary procedures. A radical debridement and an early appropriate defect coverage of the exposed prosthesis is crucial in the reconstruction process. Through a close interdisciplinary collaboration a stable soft-tissue covering can be achieved. Consequently it is possible to avoid a loss of the endoprosthesis, marked functional deficits or even amputations.