Gastroc Flaps for Coverage of Total Knee Replacements

 



 

 

Knee replacement surgeries are common procedures. Total knee replacement infections can occur between 0.3% and 12.4% for primary TKR and between 1-15% for revision TKR. When total knee infections occur, a multi-stage reimplantation is emerging as the gold standard for the treatment of infected total knees.



The first stage includes the removal of the infected prosthesis and the stabilization of soft tissues. Common flaps that are used around the knee joint include the gastrocnemius muscle flap and occasionally it is appropriate to jump directly to free microvascular tissue transfer.

At the time that the prosthesis is removed, a temporary antibiotic spacer is placed that elutes an antibiotic. Usually the antibiotic is tobramycin and often vancomycin is placed in the cement.

Typically, clinical examinations are followed and laboratory results such as CRP, ESR, and white blood cell count are monitored. Usually after a period of 6-12 weeks when all soft tissues have stabilized and are no longer hostile and an antibiotic course has been completed, then the antibiotic spacer is removed and permanent knee prosthesis is placed.



 

 



www.drbriandickinson.com

Free Latisimus Muscle Anastomosis to Popliteal Artery

Large radiation wounds or defects of the posterior aspect of the leg require vascularized tissue to heal. The free latisimus flaps offer long vascular pedicles, a significant amount of muscle for coverage.

When no vessels are available in the lower extremity, free tissue transfer can be performed by anastamosing the latisimus muscle flap to the popliteal artery and a saphenous vein branch for arterial outflow.

www.drbriandickinson.com

Repair of Urethral Fistulas with Free Buccal Mucosal Graft and Gracillis Muscle Flap

Urethral fistulas can be a result of trauma or infection and can be a challenge to close for both the physician and patient. Closure of the wound requires urinary diversion and well vascularized tissue to close the wound. Of paramount importance when repairing urethral fistulas, is that there should be no downstream obstruction, so that a decreased resistance allows closure.

 

When there is a stricture of the urethra, a free buccal mucosal graft from the mouth can be used to substitute for the urinary epithelium. Buttressing of the buccal mucosal graft requires well vascularized tissue. The gracilis muscle is an excellent choice, for bringing in well vascularized tissue into the perineum. Hyperbaric oxygen can be a useful adjunct to faciliate wound closure.

 



www.drbriandickinson.com