Introduction Risk factors systemic factors diabetes mellitus vascular disease inflammatory arthritides such as rheumatoid arthritis certain medications (immunosuppressives) tobacco use poor nutritional status albumin <3.5g/dL total lymphocyte count <1,500/uL perioperative anemia morbid obesity (BMI >40 kg/m^2) local factors previous incisions skin bridges should be >5-6cm avoid crossing previous skin incisions at an angle <60 degrees use most lateral incision possible knee deformity skin adhesions poor local blood supply technique large subcutaneous skin flaps short incisions requiring vigorous skin traction not preserving subcutaneous fat layer long surgical time long tourniquet time postoperative hematoma infection early (first 4 days) knee flexion beyond 40 degrees in a high risk knee Presentation History multiply operated knee prior infection Symptoms persistent knee pain persistent drainage beyond the early postoperative period (7 days) Physical exam wound breakdown erythema warmth drainage peri-incisional eschar Imaging Radiographs may help rule-out deep infection. looks for bone resorption Bone scan radionuclide studies if infection suspected but aspiration and serology not confirmatory Angiography if flow through sural arteries in question and gastrocnemius flap planned Treatment Nonoperative local wound care +/- antibiotics indications may be appropriate for some small superficial wounds patients who are not surgical candidates Operative debridement and coverage with rotational flap indications full-thickness necrosis medial gastrocnemius rotational flap (medial sural artery): anterior and medial defects lateral gastrocnemius rotational flap (lateral sural artery): lateral defects
Technique Guide Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. TKA Revision Orthobullets Team Recon - High Tibial Osteotomy Technique Guide Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. TKA - Parapatellar Approach Derek Bernstein Stephen Incavo Recon - High Tibial Osteotomy
QUESTIONS 1 of 2 1 2 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ04.103) A 62-year-old female underwent a primary total knee arthroplasty of the left knee 10 days ago. She presents to clinic with skin necrosis of the midline incision. There is no deep infection present upon aspiration of the knee joint. She undergoes superficial irrigation and debridement and is left with exposed patellar tendon as shown in Figure A. What is the most appropriate next step in management? Review Topic | Tested Concept QID: 1208 FIGURES: A Type & Select Correct Answer 1 Split thickness skin grafting 5% (92/1945) 2 Twice daily wet-to-dry dressing changes with Dakin's solution until healing by secondary intention 1% (26/1945) 3 Latissimus dorsi free flap transfer 1% (25/1945) 4 Vacuum-assisted closure device until healing by secondary intention 7% (128/1945) 5 Medial gastrocnemius muscle flap transfer and skin grafting 86% (1668/1945) L 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5
All Videos (3) Podcasts (0) 2018 Orthopaedic Summit Evolving Techniques Evolving Technique Update: The Frail Rheumatoid Arthritic Patient: What My Dressing Postop Will Be - Wound Vac Or New Razzle, Dazzle - Fred D. Cushner, MD (OSET 2018) Fred D. Cushner Recon - TKA Wound Complications 7/25/2019 566 views (3) Login to View Community Videos Login to View Community Videos 2017 Orthopaedic Summit Evolving Techniques 61-Year-Old with RA Develops a Small Wound Dehiscence: Old Fashion Antibiotics versus - Amar S. Ranawat, MD Amar Ranawat Recon - TKA Wound Complications 4/27/2018 149 views (0) Login to View Community Videos Login to View Community Videos 2017 Orthopaedic Summit Evolving Techniques Wound Closure: The Postoperative Dressing, CPM and Ice: So Many Options, Cost, & Do They Make A Difference? - Fred D. Cushner, MD Fred D. Cushner Recon - TKA Wound Complications 4/27/2018 290 views (3)