The Largest Series of Gastrocnemius Muscle Flaps for Salvage of Total Knee Arthroplasty
Maulin B. Shah, MA, Isaac B. James, MD, Ivan Vial, MD, Michael L. Gimbel, MD.
University of Pittsburgh, Pittsburgh, PA, USA.
Total knee arthroplasty (TKA) surgery, while generally successful, can develop devastating surgical site complications. The gastrocnemius muscle flap is the gold standard for TKA salvage. Its utility is incompletely understood due to limited data from case reports and patient series. We present the largest experience of TKA salvage using the gastrocnemius flap.
A retrospective review of all patients undergoing gastrocnemius flap for TKA salvage between 1998 and 2014 was performed in accordance with the University of Pittsburgh IRB. Indications included exposed hardware, infection, fistula, wound dehiscence and non-healing wound. Preoperative risk factors were identified. Rates of post-operative complications, need for revision, explantation, and amputation, as well as ultimate ambulation status, were analyzed.
69 patients were identified: male - 43%, average BMI - 31.4, smoker - 35%, diabetes - 32%. Primary indication for TKA was arthritis (64%). Primary indication for gastrocnemius flap was open wound (51%). 54 patients had >1 year of follow up (average 3.5 years). Of those, 33% ambulated independently, 43% ambulated with assist,13% were non-ambulatory, and 11% required amputation. Patients were less likely to independently ambulate if obese (p=0.02) or if their indication for TKA was arthritis (p=0.01). Smokers were more likely to develop flap-related complications (p=0.01).
Patients undergoing gastrocnemius muscle flap for TKA salvage showed durable long term wound stability. The gastrocnemius flap is useful in allowing patients with threatened TKAs achieve ambulation, but still has a significant salvage failure rate. This data will aid in counseling patients undergoing attempted TKA salvage.
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