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Weichteildefekte als Komplikation nach Knieendoprothetik

Operative Strategien zur Weichteilrekonstruktion

Soft tissue defects as a complication in knee arthroplasty

Surgical strategies for soft tissue reconstruction

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Zusammenfassung

Weichteildefekte nach Knieendoprothetik stellen ein schwerwiegendes Problem dar, sodass sogar die Prothese oder das gesamte Bein gefährdet sein können. Sorgfältig geplante Strategien sind für eine suffiziente Defektdeckung notwendig, die ein möglichst optimales funktionelles und ästhetisches Ergebnis gewährleisten.

Der vorliegende Beitrag erläutert die Stadieneinteilung der Weichteildefekte und stadienangepasste Möglichkeiten der operativen Sanierung. Neben den für alle Stadien gleichen grundlegenden Therapieprinzipien der Ruhigstellung, des Débridements, der programmierten Lavage und der Antibiotikatherapie stehen heutzutage sämtliche operativen Mittel der rekonstruktiven Chirurgie zur Verfügung. Dazu zählen die Hauttransplantation, lokale fasziokutane Verschiebelappen, gestielte lokale Muskellappenplastiken und freie Lappenplastiken. Für den optimalen Erfolg ist folglich ein interdisziplinäres Regime von Orthopäden, Plastischen Chirurgen, Mikrobiologen und Physiotherapeuten notwendig.

Abstract

Soft tissue defects after knee arthroplasty are a severe problem, which can even result in a loss of the prosthesis or the limb. Well-planned strategies are necessary for sufficient soft tissue reconstruction, resulting in optimal functional and aesthetic results.

This report provides information on the classification of the tissue defects and the appropriate options for surgical reconstruction. Besides the basic therapy principles of immobilisation, débridement, planned lavages and antibiotic therapy, defect-dependent surgical techniques of reconstructive surgery are implemented. These include skin transplantation, local fasciocutaneous flaps, local pedicled muscle flaps and free flaps. For best results, interdisciplinary treatment by orthopaedic surgeons, plastic surgeons, microbiologists and physiotherapists is mandatory.

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Authors and Affiliations

  1. Abteilung für Plastische und Wiederherstellungschirurgie, Klinikum rechts der Isar, Technische Universität, München

    L. Kovacs, A. Zimmermann, C. Taskov, N. A. Papadopulos & E. Biemer

  2. Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität, München

    P. Juhnke

  3. Abteilung für Plastische und Wiederherstellungschirurgie, Klinikum rechts der Isar, Technische Universität, Ismaninger Straße 22, 81675, München

    L. Kovacs

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  1. L. Kovacs
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  2. A. Zimmermann
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  3. P. Juhnke
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  4. C. Taskov
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  5. N. A. Papadopulos
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  6. E. Biemer
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Correspondence to L. Kovacs.

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Kovacs, L., Zimmermann, A., Juhnke, P. et al. Weichteildefekte als Komplikation nach Knieendoprothetik. Orthopäde 35, 162–168 (2006). https://doi.org/10.1007/s00132-005-0909-3

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