2006 - UZ Leuven

classification for judging the persistent impairment after replantation,like there is for amputation. The advantage of low costs for medicaltreatment in case of stump providing will be lost over time due to costsarising for continuing disability which have to be paid until retirement.PEETERS W., HIERNER R., REYNDERS P.: Simultaneous free flapcoverage in total knee joint replacement: - indications and results.Chirurgica, 2006: 101: 20Objective: Insufficient soft tissue prior to prosthetic implantation is oneof the most important reasons for postoperative soft tissuecomplications and/or joint stiffness.Methods: In a retrospective clinical study 10 patients who underwentfree latissimus dorsi flap together with total knee prosthesis arereviewed. Follow-up ranges between 6 to 30 (average: 23) months.Study criteria were primary wound healing, complications and activerange of motion.Results: Primary wound healing could be achieved in all patients. In 2patients skin necrosis occurred at the recipient site making a secondoperation (1 skin graft, 1 fasciocutaneous flap) necessary. In 2patients with preexisting osteomyelitis infection occurred, and had tobe treated with serial debridements. However no prosthesis had to beremoved. Active range of motion after combined prosthesisimplantation and flap transfer showed on average Ex/Flex 0-10-70°.Conclusions: Free flap transfer together with total knee jointreplacement in an exceptional indication. Simultaneous flap transfer incase of insufficient soft tissues can successfully prevent postoperativestiffness. In case of postoperative tissue breakdown, the pedicledmedial gastrocnemius muscle flap is the treatment of choice, and willlead to reliable results, if done early. In case with tissue breakdownand prosthetic show, removal of prosthesis is only indicated in case ofprosthetic loosening and persisting deep infection. After adequatedebridement, and especially a complete synovialectomy the defectcan be covered by well vascularized muscle tissue in a single-stageprocedure. Alternatively a VAC can be placed after debridement andflap coverage can be done 3 – 7 days later; after reevaluation of(systemic and local) infection parameters.PEETERS W., HIERNER R. VAN DEN KERCKHOVE E.: High pressureinjection injuries of the hand: a case report of an industrial painter.Chirurgica, 2006; 101: 41.88