Modified vastus lateralis flap in treating a difficult hip infection.
BACKGROUND
Difficult-to-treat hip infections are typically a reconstructive challenge to orthopedic surgeons. Treatment regimens must be tailored to each patient on the basis of an overall evaluation of systemic host factors and local wound factors. To treat a medically ill patient with compromised local wounds in the hip area, a modified vastus lateralis flap transposition was developed. This flap transposition is of a simple design and effective as both a soft-tissue coverage and a dead space filler.


METHODS
From January 2002 to June 2003, 10 patients (5 male patients and 5 female patients) suffering difficult hip infections were referred to Chang Gung Memorial Hospital at Chia-Yi for further treatment. Before visiting the clinic, each patient had undergone repeated failed operations, including debridement, introduction of antibiotic-loaded cement spacers, and fasciocutaneous flap transposition. After being diagnosed with difficult hip infections, these patients were treated with the modified vastus lateralis flap transposition immediately after radical debridement. The average follow-up period was 17.4 months (range, 9-27 months).


RESULTS
The hip infections in all 10 patients were controlled and the wounds healed uneventfully. The need for another soft-tissue procedure was not indicated. The C-reactive protein returned to a near-normal and stable level within 1 month. The only complication occurred when case 1 developed a contralateral iliopsoas abscess and secondary septic hip 9 months after the procedure. There was no morbidity or mortality related to the technique.


CONCLUSIONS
For medically ill patients with compromised local wounds, the modified vastus lateralis muscle flap transposition after radical debridement is a simple and effective way of resolving refractory and limb-threatening hip infections.
Huang
Kuo-Chin
KC
Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Chia-Yi, Pu-Tz City, Taiwan. kc2672@adm.cgmh.org.tw
Peng
Kuo-Ti
KT
Li
Yen-Yao
YY
Tsai
Yao-Hung
YH
Huang
Tsung-Jen
TJ
Hsu
Robert Wen-Wei
RW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D005260:Female; D006621:Hip Joint; D006801:Humans; D008297:Male; D008875:Middle Aged; D003668:Pressure Ulcer / Q000150:complications; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000601:surgery*; D011832:Radiation Injuries / Q000150:complications; D012086:Reoperation; D012307:Risk Factors; D013524:Surgical Flaps; D014946:Wound Infection / Q000209:etiology / Q000601:surgery*