Vastus Lateralis Flap Reconstruction After Girdlestone Arthroplasty

Abstract

Pressure ulcers are found in approximately 4.7% of hospitalized populations. Up to 12.3% of hospitalized populations are at risk for developing these wounds. Decubitus ulcers are more common among the inpatient spinal cord injury group, with prevalence rates up to 30%. Surgical intervention is required when bone or the hip joint becomes involved. Girdlestone arthroplasty is a procedure that excises affected proximal femur and acetabular tissues; however, this resection typically results in a sizeable defect. The vastus lateralis flap has been extensively reviewed as a soft tissue filler option for this deficit. Thirteen consecutive cases from a single institution using the vastus lateralis muscle flap reconstruction after Girdlestone arthroplasty were reviewed. A search of internal records identified 11 patients with 13 vastus lateralis flap reconstructions performed immediately after Girdlestone arthroplasty for stage 4 ulcers or chronic, infected wounds affecting the hip joint. All patients involved were subjected to a similar standardized post-procedure activity schedule. Complications were defined as minor (superficial wound breakdown) or major (requiring further operative procedures to close the wound). The majority of patients were male (91%) with a mean age of 43 years at the time of the procedure. All wounds involved the hip joint proper. Ninety-one percent of the patients had a history of spinal cord deficits. Thirty-one percent of the flaps had minor, superficial wound breakdown. Another 31% of the reconstructions required an additional operative procedure for major wound complications. One patient's wound was from multiple prior failed hip replacements. He eventually became ambulatory using a walker after reconstruction. Ultimately, 69% of the flaps healed satisfactorily without the need for further operative intervention. Surgical debridement is required for chronic wounds involving the proximal femur, acetabulum, and hip joint. This review demonstrates that the use of a single-stage procedure including Girdlestone arthroplasty with immediate vastus lateralis muscle flap reconstruction is a practical treatment option for chronic wounds involving the acetabular joint. The use of a postoperative protocol and subsequent sitting schedule contributed to the success of these reconstructions. Overall, this procedure is applicable to spinal cord injury/pathology patients and to failed total hip arthroplasty patients for future assisted ambulation.