Objective To evaluate the clinical treatment methods of deep infection after total knee arthroplasty (TKA) and its effectiveness. Methods Between January 2004 and January 2010, 32 cases (32 knees) of deep infection after TKA were treated, including 13 males and 19 females with an average age of 64.6 years (range, 52-79 years). The time from primary TKA to infection was 3 weeks to 10 years. The preoperative knee society score (KSS) was 104.6 ± 9.1, and the visual analogue scale (VAS) score was 7.8 ± 1.4. Open debridement and continuous irrigation were perfomed in 3 cases of acute infection, arthroscopic debridement and irrigation in 3 cases of acute haematogenous infection; in 26 cases of chronic deep infection, 9 cases underwent open debridement, 4 cases underwent antibiotics impregnated bone cement spacer, 12 cases received two-stage revision, and 1 case underwent conservative treatment by intravenous antibiotics. Results All cases of acute infection failed to control deep infection; 1 case of acute haematogenous infection failed to treat; 7 cases of chronic infection undergoing debridement and 1 case of conservative treatment failed to treat; and all the failure cases were cured after symptomatic treatment. Thirty-two cases were followed up 2-8 years (mean, 4.6 years). At last follow-up, the KSS score and VAS score were 158.4 ± 8.3 and 4.1 ± 0.8, respectively, all showing significant differences when compared with preoperative scores (P lt; 0.05). Re-infection occurred in 3 patients who received two-stage revision during follow-up. Conclusion In patients with acute infection of methicillin-resistant Staphylococcus aureus after TKA, open debridement and liner change have low success rate; arthroscopic debridement can be performed to control acute haematogenous infection; and two-stage revision is an effective method to control chronic infection and restore the knee function, but two-stage revision has a potential risk of re-infection.
Objective To investigate the method and effectiveness of vacuum seal ing drainage (VSD) combined with debridement for treatment of deep infection after hip or knee replacement. Methods Between September 2006 and May 2010, 13 cases of deep infection after joint replacement surgery were treated, including 5 males and 8 females with an average ageof 62.5 years (range, 56-78 years). Infection occurred at 7 days to 1 year and 2 months (median, 14 days) after joint replacement surgery. The time from infection to admission was 8 days to 4 years and 6 months (median, 21 days). Purulent secretion with or without blood were observed in all patients; sinus formed in 5 cases; and unhealing of incision or drainage opening disunion were observed in 8 cases. The size of skin defect at secretion drainage or sinus opening site was 5 mm × 3 mm to 36 mm × 6 mm; the depth of drainage tunnel or sinus was 21-60 mm. The histopathological examination in 11 patients showed acute infection or chronic infection with acute onset in 10 cases, and tuberculosis in 1 case. In 6 cases of secretion culture, Staphylococcus aureus was isolated from 5 cases. After thorough debridement, wound irrigation was performed during the day and VSD during the night in 10 cases. VSD was merely performed in 3 cases. Results In 1 case after revision total hip arthroplasty, the wound bled profusely with VSD, then VSD stopped and associated with compression bandage, VSD proceeded again 3 days later with no heavy bleeding. All the patient were followed up 1 year to 4 years and 5 months (mean, 2 years and 11 months). Infection were controlled 7-75 days (mean, 43 days) after VSD in 10 cases. In these cases, prosthesis were reserved, no recurrent infection was observed, wound were healed, limb function were reserved. VSD was refused in 1 case because of hypersensitive of the pain at the vacuum site, infection control was failed and amputation at the thigh was proceeded. The effect was not evident in 1 case with tuberculosis infection, then the prosthesis was removed and arthrodesis was proceeded followed by complete union. In 1 case, infection was cured with VSD, recurrent infection happened after 9 months, antibiotic-impregnated cement spacer was used at end, and no recurrence was observed 1 year and 4 months later. Conclusion VSD combined with debridement can drainage deep infection sufficiently, promote wound healing, reduce recurrent infection rate, maximize the possibil ity of prosthesis preservation.
ObjectiveTo study the effect of deep sternal wound infections（DSWIs）treated by the techniques of pectoral major muscular(PM) turnover and non-suture remain after the wound restitution.MethodWe retrospectively analyzed the clinical data of 23 patients with DSWIs in our hospital between June 2016 and December 2016. There were 13 males and 10 females at age of 4-73(54.5±19.5) years. There were 8 patients with concomitant diabetes mellitus and 1 patient with chronic obstructive pulmonary disease(COPD) and brain infarction. Eigteen patients were of type Ⅱ, 5 patients of type Ⅲ according to Pairolero’ classification in the DSWIs. Five patients were with remaining abscess cavity in the mediastinum by thoracic compute tomography(CT). Under general anesthesia the DSWIs debrided thoroughly. The PM elevated from the anterior pectoralis major fascia off subcutaneous tissue to lateral to anterior axillary line, the PM cutted off, then made to the muscle flap, turnover PM flap filled and fixed to sternal wound by lighten tensile suture, the subcutaneous tissue and skin sutured by cutting full-thickness.ResultsThe sternal reconstruction after debridement of the sternal wound was used by bilateral PM flap in the 17 patients, unilateral PM in 6 patients. There were 21(91.3%) patients in stage Ⅰ healing, 2 patients deferment healing of local cut skin without reoperation. There were 22 patients with non-paradoxical breathing during the postoperation. One death resulted from multiple-organ failure of the concomitant disease. The average of hospital day was 10.6 days. The wound healing was good by chest CT at 1 month after the operation.ConclusionThe sternal forming by the technique of the PM flap turnover, without remain of fremde stoffe in wound for DSWIs is distinctive method, evident effect.