Management of wounds of exposed or infected knee prostheses.

Skin damage after total knee arthroplasty may jeopardise the functional benefit of the prosthesis. In such cases standard treatment is aimed at avoiding arthrodesis, sometimes replacing the implant and, in exceptional cases, amputation. In most cases early and adequate coverage of the soft tissue defect may make it possible to salvage the prosthesis. Ten patients with skin damage after total knee arthroplasty were treated by debridement of the wound, which was then covered with a pedicled gastrocnemius muscle flap. This was supported by local irrigation and systemic antibiotics. Seven patients were reviewed after a mean follow-up of 28 months (range 14-59). Six patients kept their prostheses and one had a relapse caused by infection at 22 months, which required removal of the prosthesis and secondary arthrodesis. The gastrocnemius muscle flap provides good quality coverage, permits early mobilisation and fast rehabilitation, and reduces the rate of arthrodesis after failure of total knee arthroplasty.

[Use of "foot-bank" tissue to cover amputation stumps. Apropos of 4 cases]. / Utilisation du "pied-banque" pour la couverture des moignons d'amputation. A propos de 4 cas.

PURPOSE OF THE STUDY: The authors report 4 cases of plantar skin free transfer to cover an amputation stump. MATERIAL AND METHODS: In two cases, operated as emergencies, a flap based on the posterior tibial pedicle was harvested from a non-reimplantable extremity. In one case the calcaneum was included in the flap to provide a stump wide enough to hold a prosthesis. The two others cases concerned planned amputation of non-functional extremities, with free transfer of the available plantar skin areas. RESULTS: All 4 patients healed well and the skin coverage provided a good quality stump which was rapidly equipped with prostheses. DISCUSSION: Covering amputation stumps with a free flap from the foot bank has proven to be a reliable procedure, economic for the patient, affording a good physiologic bearing surface. CONCLUSION: This method should proposed in emergency amputations according to local conditions, and may also be advantageous in some cases of secondary surgery.

[Vaginal reconstruction by musculocutaneous flap of the rectus abdominis after pelvic cancer surgery. Apropos of 11 cases]. / Reconstruction vaginale par lambeau musculo-cutané du grand droit abdominal après chirurgie pelvienne pour cancer. A propos de onze cas.

Surgical treatment of gynecological neoplasms leads to two problems: pelvic defect, and vaginal reconstruction. The authors have been using rectus abdominis musculo-cutaneous flap as described by Tobin. Eleven patients have been treated. A horizontal flap was used in one patient and a vertical one for the 10 other patients. The authors had one failure. In the ten other patients the average healing time was 21 days and 5 patients were able to return to sexual activities. The use of rectus abdominis flap would appear to be an easy and reliable technique for pelvic reconstruction.