title: Wound healing problems in total knee arthroplasty.
abstract: It is important to avoid underestimating the significance of wound complications following total knee arthroplasty (TKA). Expedient and aggressive care is recommended. Understanding the blood supply to the skin around the knee and measures to prevent wound complications are fundamental to preventing wound problems. A detailed patient history and physical examination will identify high-risk patients and any modifiable risk factors. Operative techniques such as raising full-thickness skin flaps and judicious placement of skin incisions in the presence of pre-existing scars can greatly reduce the incidence of wound problems. The first step in treating wound problems is recognizing when a problem is present and knowing when a minor problem can turn into a major one. Superficial infections or stitch abscesses can be treated with conservative treatment. However, the surgeon should have a low threshold to revert to surgical management if drainage persists. Skin necrosis or non-viable skin must be excised in the operating room, and the presence of a deep infection must be diagnosed by joint aspiration. The appropriate course of action in dealing with deep infection is dependent on the duration elapsed since the index procedure. The ability to perform a medial gastrocnemius muscle flap and skin graft is an invaluable skill in complex cases where primary wound closure cannot be achieved. Meticulous attention to detail during surgery and aggressive surgical treatment of wound complications can be the difference in saving the knee.
authors: Mount Sinai Hospital, Room 476, 600 University Ave, Toronto, Ontario, M5G 1X5, Canada. garbedian@gmail.com
authors: Shawn
authors: S
authors: Garbedian
authors: Amir
authors: A
authors: Sternheim
authors: David
authors: D
authors: Backstein
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D006801:Humans; D007717:Knee / Q000098:blood supply / Q000601:surgery; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D013524:Surgical Flaps; D013529:Surgical Wound Dehiscence / Q000209:etiology* / Q000601:surgery; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000209:etiology*; D014945:Wound Healing / Q000502:physiology*