Skin necrosis after SUPERknee procedure – typical versus modified surgical approach.
AbstractIntroductionSUPERknee procedure (SK) is a solution for complex knee instability in children with congenital deformations. The operation involves ACL and PCL reconstruction with fascia lata, patella realignment and knee contracture correction. Due to wide surgical approach and long time of surgery (ST) the skin around the knee is in risk of ischemic necrosis (SN) or healing complications (HC). PurposeThe purpose of the study is to compare incidence of SN in SK using typical and modified approach. MethodsSixteen patients un derwent SK since 2015 till 2016, 8 boys, 8 girls in mean age 8.1 (4.3-12.7)y.o. In 8 cases SK and in 8 SK combined with SUPERhip (SK+SH) was performed. In 6 patients (3 SK and 3 SK+SH) the approach was performed according to typical description from one incision (OIA). In 10 patients (5 SK and 5 SK+SH) a modified approach was performed, involving additional skin incision at the medial side of knee for PCL graft attachment (DIA). The occurrence of SN, ST and risk factors of HC were evaluated. Result SN appeared in 2 cases treated with OIA (33%). There was no SN in DIA (0%). With this number of patients the difference was below level of significance, p=0.1250, OR=11.7. The mean follow-up was 30.2 (26-41) months. In both cases SN was situated at the anterolateral aspect of knee. In one patient treated with SK+SH area of SN was 17.5 cm2. In the other patient treated with SK 35 cm2. Both were healed with a skin scar. Mean ST in SK was 3.4h (2.5-4.0) and in SK+SH 4.6h (4.0-5.5). ST in cases with skin necrosis was similar to the mean ST for each group. ST of the surgery with OIA was 4.1h (2.5-5.5) and in DIA 3.7h (3.0-4.5), p=0.4746. The prior knee surgery was present in one patient with SN operated with OIA and in 3 patients with normal healing operated with DIA. No additional risk factor relevant to SN was found. ConclusionsThe double skin incision surgical approach for the SUPERknee procedure may decrease incidence of the wound healing complications and the skin necrosis. It should be considered in all cases, especially in patients with previous surgeries in the knee area and additional with risk factors. It does not extend the time of the surgery.
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