title: [Systemic therapy for defects of skin and soft tissue on the knees after severe trauma or burn].
abstract: OBJECTIVE
  To explore the methods of systemic treatment of defects of skin and soft tissue on the knees after severe trauma or burn.
  
  
  METHODS
  Twenty patients with defects of skin and soft tissue on the knees after severe trauma or burn hospitalized in our center from January 2009 to December 2011. The injury areas on the knees ranged from 5 cm×4 cm to 30 cm×20 cm. The wounds were treated with radical debridement, vacuum sealing drainage, and douche through dripping to control infection in early stage. Then they were covered with transplantation of skin grafts plus flap or only with flap. Totally 8 local flaps (including 6 local rotation or transposition flaps and 2 saphenous artery flaps) and 12 free flaps (including 8 anterolateral thigh flaps and 4 latissimus dorsi musculocutaneous flaps) were used. The flap size ranged from 6 cm×5 cm to 32 cm×22 cm. The rehabilitation training of the knee joints was carried out in the early stage after wound healing.
  
  
  RESULTS
  All free skin grafts and flaps used in 15 patients survived. Thirteen of them were primarily healed, while some small parts of skin grafts of the other two patients were in poor condition because of infection, and they healed after another session of skin transplantation. Infection occurred under the free flap in one of the 5 patients transplanted with flaps only, which was healed after continuous douche through dripping and another surgical debridement following wet dressing. The knee joints were in good function during the follow-up period of 1 - 3 years.
  
  
  CONCLUSIONS
  The systemic therapy of radical debridement, vacuum sealing drainage technique, douche through dripping, transplantation of large autologous grafts and flaps, and the early rehabilitation training are effective and reliable in repairing defects of skin and soft tissue at the knee region after severe injuries.
authors.affiliation: Burn Center of PLA, Department of Burns and Cutaneous Surgery, Xijing Hospital, the Fourth Military Medical University, Xi'an 710032, China.
authors.forename: Ke
authors.initials: K
authors.lastname: Tao
authors.forename: Da-hai
authors.initials: DH
authors.lastname: Hu
authors.forename: Xiong-xiang
authors.initials: XX
authors.lastname: Zhu
authors.forename: Jun-tao
authors.initials: JT
authors.lastname: Han
authors.forename: Zhao
authors.initials: Z
authors.lastname: Zheng
authors.forename: Song-tao
authors.initials: ST
authors.lastname: Xie
authors.forename: Jin-bo
authors.initials: JB
authors.lastname: Ge
authors.forename: Xiao-long
authors.initials: XL
authors.lastname: Hu
mesh_terms: D000293:Adolescent; D000328:Adult; D002056:Burns / Q000150:complications*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016038:Skin Transplantation; D017695:Soft Tissue Injuries / Q000601:surgery*; D013524:Surgical Flaps; D055815:Young Adult