Strategies for soft tissue management of complex joint revision arthroplasty - a ten-year experience.

Background: 160,000 joint replacements are performed each year in the UK. After multiple revisions, soft tissues become sub-optimal and chronic wounds develop causing infection or metalwork extrusion. We present our experience of 155 patients at a tertiary orthopaedic hospital. Methods: A chart review of patients whom required reconstruction as a result of complex joint revision surgery was performed between January 2006 and January 2015. All primary joint replacements were excluded. Results: 119 flaps were performed, 28 were managed conservatively and eight were treated with primary amputations. 84 of the patients (71%) who had soft tissue reconstruction were healed at one-year follow up. Seven primary free flap failures occurred (11%), of these four out of seven patients underwent a second successful free flap reconstruction. A further 12 patients underwent secondary amputation as a result of persistent periprosthetic infection and 11 patients were managed with long-term oral antimicrobial therapy after declining amputation. Conclusions: The best results are achieved using a combined approach with multi-disciplinary input from orthopaedic and plastic surgeons with constant specialist clinical microbiology input. All patients had deep tissue samples taken, a long-line inserted and according to microbiology advice, a tailored 6-week regime of intravenous antibiotics. The data supports that early plastic surgery involvement achieved better patient outcomes. (C)2016American Society of Plastic Surgeons

from #ENT via xlomafota13 on Inoreader http://ift.tt/2b3dCdp
via IFTTT