Parallel biomechanical imbalance of the load supporting contour in patients with hip prosthesis and the reconstruction of the ACL

Abstract

Serial debridement of tissue affected by necrotising fasciitis results in extensive and deep wounds, sometimes complicated by the exposure of major vessels, tendons, bone or other tissue incapable of supporting healing by skin grafts alone. When skin grafts are used, their contraction can result in contracture of joints, or the neck. On the other hand, reconstruction using tissue flaps can be bulky, with poor contour definition and healing of both reconstruction, and donor site, may be compromised by patient comorbidity and instability. In our institution, concerns regarding infection and loss of dermal substitutes of biological origin in these scenarios (e.g. collagen/glycosaminoglycan) have precluded their use. We present a series of seven consecutive cases of such challenging wounds; temporised and reconstructed with a totally synthetic polyurethane dermal substitute and secondary skin grafting, resulting in durable cover with minimal contracture. The cohort includes anterior neck defects exposing major vessels (2/7), multiple exposed ribs on the chest wall (2/7), lower limbs crossing knee or ankle joints (3/7) and a lower limb amputation by hip disarticulation (1/7). This is the first published series of the use of a completely synthetic dermal substitute in necrotising fasciitis wounds, and the joint largest using any dermal substitute.