Skin necrosis after SUPERknee procedure – typical versus modified surgical approach

Milud Shadi; Piotr Janusz; Paweł Koczewski; Michał Walczak; Joanna Kraśny; Tomasz Kotwicki

doi:10.20883/jms.337

Authors

Milud Shadi Department of Spine Disorders and Pediatric Orthopedics, Poznan University of Medical Sciences, Poland https://orcid.org/0000-0002-8751-0243
Piotr Janusz Spine Disorders Unit, Department of Spine Disorders and Pediatric Orthopedics, Poznan University of Medical Sciences, Poland https://orcid.org/0000-0001-5702-4933
Paweł Koczewski Department of Pediatric Orthopedics and Traumatology, Poznan University of Medical Sciences, Poland https://orcid.org/0000-0001-8063-4000
Michał Walczak Department of Pediatric Orthopedics and Traumatology, Poznan University of Medical Sciences, Poland https://orcid.org/0000-0001-5843-2680
Joanna Kraśny Department of Pediatric Orthopedics and Traumatology, Poznan University of Medical Sciences, Poland https://orcid.org/0000-0003-2419-1166
Tomasz Kotwicki Department of Spine Disorders and Pediatric Orthopedics, Poznan University of Medical Sciences, Poland https://orcid.org/0000-0003-0810-9361

DOI:

https://doi.org/10.20883/jms.337

Keywords:

SUPERknee, SUPERhip, super knee, super hip healing complications, skin necrosis

Abstract

Introduction. SUPERknee procedure (SK) is a treatment for complex knee instability in children with congenital deformations. 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).
Aim. The purpose of the study is to compare incidence of SN in SK using typical and modified approach.
Material and Methods. Sixteen patients underwent SK since 2015 till 2016, 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 from one incision (OIA). In 10 patients (5 SK and 5 SK+SH) a modified approach was performed, involving additional skin incision (DIA). The occurrence of SN, ST and risk factors of HC were evaluated.
Results. 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. In one patient treated with SK+SH area of SN was 17.5 cm2. In the other patient treated with SK 35 cm2. Mean ST in SK was 3.4h (2.5–4.0) and in SK+SH 4.6h (4.0–5.5). 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. No additional risk factor relevant to SN was found.

Keywords: SUPERknee, SUPERhip, super knee, super hip, healing complications, skin necrosis.

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References

Mindler GT, Radler C, Ganger R. The unstable knee in congenital limb deficiency. Journal of children's orthopaedics. 2016;10(6):521–8.

Paley DGF. Lengthening Reconstruction Surgery for Congenital Femoral Deficienc. In: Kocaoğlu MTH, Eralp L, editor. Advanced Techniques in Limb Reconstruction Surgery. Berlin, Heidelberg: Springer; 2015.

Paley D. Surgical reconstruction for fibular hemimelia. Journal of children's orthopaedics. 2016;10(6):557–83.

Prince DE, Herzenberg JE, Standard SC, Paley D. Lengthening With External Fixation Is Effective in Congenital Femoral Deficiency. Clinical orthopaedics and related research. 2015;473(10):3261–71.

Paley DCDY, Prince DE. Congenital Femoral Deficiency Reconstruction and Lengthening Surgery. In: S S, editor. Pediatric Lower Limb Deformities: Principles and Techniques of Management. Springer, Cham; 2016. p. 361–425.

Paley D. Tibial hemimelia: new classification and reconstructive options. Journal of children's orthopaedics. 2016;10(6):529–55.

Kaastad TS, Tveter AT, Steen H, Holm I. Physical function and health‑related quality of life in young adults with unilateral congenital lower‑limb deficiencies. Journal of children's orthopaedics. 2017;11(5):348–57.

Hamdy RC, Makhdom AM, Saran N, Birch J. Congenital fibular deficiency. The Journal of the American Academy of Orthopaedic Surgeons. 2014;22(4):246–55.

Langenskiold A, Ritsila V. Congenital dislocation of the patella and its operative treatment. Journal of pediatric orthopedics. 1992;12(3):315–23.

Amirault JD, Cameron JC, MacIntosh DL, Marks P. Chronic anterior cruciate ligament deficiency. Long‑term results of MacIntosh's lateral substitution reconstruction. The Journal of bone and joint surgery British volume. 1988;70(4):622–4.

Grammont PM, Latune D, Lammaire IP. Treatment of subluxation and dislocation of the patella in the child. Elmslie technic with movable soft tissue pedicle (8 year review). Der Orthopade. 1985;14(4):229–38.

Paley D SSC. Lengthening Reconstruction Surgery: for Congenital Femoral Deficiency. In: S. Robert Rozbruch SI, editor. Limb Lengthening and Reconstruction Surgery. 1st ed. Boca Raton CRC Press 2006

Vince K, Chivas D, Droll KP. Wound complications after total knee arthroplasty. The Journal of arthroplasty. 2007;22(4 Suppl 1):39–44.

Jones RE, Russell RD, Huo MH. Wound healing in total joint replacement. The bone & joint journal. 2013;95-B(11 Suppl A):144–7.

Pujol N, Boisrenoult P, Beaufils P. Post‑traumatic knee stiffness: surgical techniques. OTSR. 2015;101(Suppl 1):S179–86.

Johnson DP, Eastwood DM, Bader DL. Biomechanical factors in wound healing following knee arthroplasty. Journal of medical engineering & technology. 1991;15(1):8–14.