[Management of skin necrosis around incision following total knee arthroplasty].

OBJECTIVE

To investigate the risk factors of skin necrosis around incision after total knee arthroplasty (TKA), and explore the measures of prevention and treatment.

METHODS

Between June 2007 and June 2013,7 patients with skin necrosis around incision after TKA were treated. There were 5 males and 2 females with an average age of 69 years (range, 59-78 years), including osteoarthritis in 4 cases, traumatic arthritis in 2 cases, and rheumatoid arthritis in 1 case. Two cases complicated by diabetes, and 2 cases by hypertension; 1 case received long-term hormone therapy; and 2 cases had a history of smoking. Scar was seen near knee joint in 2 cases. The skin necrosis ranged from 10 cm x 2 cm to 13 cm x 8 cm. The time from TKA to debridement was 7-15 days (mean, 12 days). After thorough debridement, the saphenous artery skin flap, medial head of gastrocnemius muscle flap, lateral head of gastrocnemius muscle flap were used in 4 cases, 2 cases, and 1 case respectively; reconstruction of patellar ligament was performed in 2 cases. Donor sites were repaired by split-thickness skin graft.

RESULTS

All the flaps and myocutaneous flaps survived well, and all wounds healed by first intention. At donor site, the grafted skins survived and wounds healed by first intention. No early complication occurred. All cases were followed up 6-12 months (mean, 7.8 months). The flaps and myocutaneous flaps had good texture and appearance; no prosthetic loosening and displacement happened, no secondary infection was observed after operation. The knee range of motion was 45-110 degrees (mean, 85 degrees) at 6 months after operation. According to the Knee Society Score (KSS), the results were excellent in 3 cases, good in 2 cases, general in 1 case, and poor in 1 case at 6 months after operation.

CONCLUSION

Early discovery, thoroughly debridement, and timely repair with axial pattern flap or myocutaneous flap are the key factors to treat skin necrosis around incision after TKA and save the artificial prosthesis.