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J Knee Surg 2020; 33(07): 732-744
DOI: 10.1055/s-0039-1684012
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Soft Tissue Reconstruction for Deep Defects over a Complicated Total Knee Arthroplasty: A Systematic Review

Demetrius M. Coombs
1   Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Jessica Churchill
2   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Paul Cartwright
3   Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
,
Morad Chughtai
2   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Assem A. Sultan
2   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Linsen T. Samuel
2   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Joseph T. Moskal
4   Department of Orthopaedic Surgery, Chief of Adult Reconstruction, Carilion Clinic, Roanoke, Virginia
,
Mark F. Hendrickson
1   Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Michael A. Mont
2   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
5   Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York
› Author Affiliations
Further Information

Publication History

20 November 2018

18 February 2019

Publication Date:
08 April 2019 (online)

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Abstract

Deep soft tissue defects after complicated primary or revision total knee arthroplasty (TKA) can be devastating to the patient and technically challenging. The purpose of this review was to (1) discuss different methods used to provide coverage for deep defects of the knee following TKA, as well as to (2) report on their success rates. A comprehensive literature search was performed. Reports were only included if they (1) were case series, (2) were level III studies or above (including retrospective cohort studies and meta-analyses), (3) were in English, and (4) discussed the outcome of graft or flap coverage of soft tissue defects after total knee arthroplasty. A total of 28 case series and four retrospective comparative studies were retrieved. In 16 studies, 195 out of 241 patients who received gastrocnemius flaps (81%) experienced successful outcomes. In seven studies including 84 patients that underwent fasciocutaneous flap coverage, over 90% of patients experienced successful outcomes. In the four studies examining 144 patients with delayed versus prophylactic soft tissue reconstruction, up to 81% of patients experienced a successful outcome. Various factors must be taken into consideration when assessing full-thickness defects over a TKA and collaboration between plastic and orthopaedic surgeons is required to select the optimal approach.

Keywords

flap reconstruction - deep tissue defects - outcomes - total knee arthroplasty - revision
 

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