title: Gluteus Maximus Advancement Flap Procedure for Reconstruction of Posterior Soft Tissue Deficiency in Revision Total Hip Arthroplasty.
abstract: The current study describes the surgical technique and early outcomes of a gluteus maximus advancement flap procedure for the treatment of posterior soft tissue insufficiency among patients with complex revision total hip arthroplasty. This retrospective case series was conducted with a prospective, single-institution arthroplasty registry. Patients who underwent a gluteus maximus advancement flap procedure in the setting of revision total hip arthroplasty between January 2012 and January 2016 were eligible for inclusion (N=7). Primary indications for the gluteus maximus flap procedure included periprosthetic infection with persistent wound breakdown (n=4), persistent symptomatic aseptic pseudotumor in the setting of adverse local tissue reaction after unsuccessful operative debridement (n=2), and abductor insufficiency with recurrent hip instability after unsuccessful placement of a constrained liner (n=1). All patients who underwent a gluteus maximus advancement flap procedure for chronic periprosthetic infection or adverse local tissue reaction had healing of the wound and were infection-free at the last follow-up. In the early postoperative period, 2 patients had recurrent wound infection that required flap elevation. The patients remained infection-free after the subsequent procedure. No patient had repeat instability, and no complications of flap necrosis or nerve palsy occurred. The gluteus maximus advancement flap procedure provides a diverse range of soft tissue coverage options for patients with recalcitrant periprosthetic joint infection, adverse local tissue reaction with pseudotumor, or recurrent instability. [Orthopedics. 2017; 40(3):e495-e500.].
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Ricciardi
authors.forename: Peter W
authors.initials: PW
authors.lastname: Henderson
authors.forename: Alexander S
authors.initials: AS
authors.lastname: McLawhorn
authors.forename: Geoffrey H
authors.initials: GH
authors.lastname: Westrich
authors.forename: Mathias P
authors.initials: MP
authors.lastname: Bostrom
authors.forename: Lloyd B
authors.initials: LB
authors.lastname: Gayle
mesh_terms: D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D003646:Debridement; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps