There are a number of important considerations in the management of the soft tissues overlying the hip joint, especially in the revisional arthroplasty patient. Prevention is better than cure and in reoperative joint surgery, where there may be scarred and deficient periarticular tissues. Anticipation of postoperative wound problems is essential. To avoid this, corrective measures need to be taken both pre- and intraoperatively. For example, incisions need to be designed through old scars to avoid further devascularization. Various manifestations of scarring, for example, depressed scars, multiple scars, and scar contractures, all need to be addressed preoperatively. Areas of tightness or soft tissue deficiency can be replaced or augmented with local tissue flaps. At all costs the mobility and thickness of the tissues overlying the joint prosthesis must be maintained and tension on the incision line avoided. Significant scar contractures of the hip joint can be released and the soft tissue deficiency replaced with a fair-sized myocutaneous flap, also allowing a lengthening procedure on the hip to be performed (Fig. 61.1).
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