Vacuum-assisted closure for skin necrosis after revision total knee arthroplasty

Abstract

Although skin necrosis following total knee arthroplasty or revision total knee arthroplasty is rare, it may cause severe complications. Skin changes begin with superficial infections and may result in removal of the prosthesis. Treatment of skin necrosis is an important factor, which determines the prognosis of the prosthesis. Several techniques have been defined for sufficient closure. In this article, we present the case of a patient who was treated for skin necrosis that developed after knee revision arthroplasty, using serial debridement, convergence sutures and an intermittent vacuum-assisted closure device (KCI Inc., San Antonio, TX).

Keywords: Revision total knee arthroplasty; Skin necrosis; Therapy; Vacuum-assisted closure.

© 2014 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Figures

Figure 1

The skin necrosis between two incisions.

Figure 2

After the necrotic tissue was fully removed up to the live tissue, it was seen that the retinaculum was healthy and the knee joint was not exposed.

Figure 3

After the wound ends were rejuvenated, the proximal and distal ends of the incision were approximated to the skin with sutures. Convergence sutures were inserted on four sides of the wound to come out approximately 3 cm away from the wound ends and an intermittent vacuum‐assisted closure device was used.

Figure 4

The next steps show the convergence sutures and the intermittent vacuum‐assisted closure device.

Figure 5

(A) The wound gradually healed and closed in 2 weeks. (B) Knee flexion was shown to gain 115 degrees in 2 months after closure. (C, D) The patient had no skin complications in the 5‐year follow‐up.