Preventing Total Knee Arthroplasty Infection with Microsurgery -- The Prophylactic Free Flap

Total knee arthroplasty (TKA, knee replacement surgery) is a common procedure to treat knee pain and arthritis.  Over 120,000 knee replacement surgeries are performed per year in the United States.

The surgery involves making a midline incision over the knee joint and allowing the orthopedic surgeon access to the joint area to place an implant that acts like a joint.  Once the joint is in, the skin is  closed over and allowed to heal.  Often, the knee is started on a range of motion protocol to prevent stiffness.

On rare occasions, the knee skin may not be viable, sturdy, or durable to allow the surgeon to perform the knee replacement surgery because the closure of the soft tissue may be difficult   (history of trauma with scar, thin skin, skin grafts, psorasis, etc)  .  If the skin can be properly closed over the implant, this is a serious situation for the viability of the implant and the leg.  An exposed implant is an infection and can lead to serious complications.

At our center, we have worked with several of our orthopedic surgeons who have had the foresight to seek plastic surgery consultation to avoid a "skin" or soft tissue problem prior to the TKA.   This allows for us to create a coordinated effort to first place durable, strong skin tissue/flap over the knee area prior to the TKA.  Typically, a skin flap from the thigh or back can be transplanted over the knee area as a microsurgical free tissue transfer.  After 3-6 months when the flap is well healed and ready for elevation, the orthopedic surgeon can then place the TKA under the flap tissue and can easily close over the implant with the additional durable skin cover.

This sequence of events is a shift away from current treatment strategies that may lead to a higher rate of failure and infection. Often times, the skin/soft tissue issue is not addressed early, and the plastic surgeon is called in on an "emergency" basis to help close over the implant.  This is not an ideal situation as this prolongs the operation, may not allow for proper setup or anatomic exposure of the tissues, etc.

To learn more about the the "prophylactic free flap over the total knee", please feel free to contact us.  Lplasticsurgery@gmail.com

Most Efficient Procedure Available to Treat Varicose Veins?

A: Efficient treatments include endovenous ablation with laser and radiofrequency, and correct diagnosis

Varicose veins are almost never formed in isolation; there is most often, a deeper, larger, vein that is "incompetent" that connects to the superficial, visible varicose vein.  This incompetent vein is usually the greater or lesser saphenous vein with valves that are not functioning normally.   These root cause veins typically give rise to the varicose veins seen on the surface, and thus, to treat the varicose most effectively, the incompetent saphenous vein needs to be diagnosed first with a duplex ultrasound.  Once identified, the vein can be treated with laser or radiofrequency (EVLT or VNUS), and the microphlebectomies performed at the same time to remove the varicose veins.  This can most often be performed under local anesthesia under 1 hr with the patient able to walk right away.   
These treatments are highly efficient and effective and far less problematic than the old "vein stripping" techniques of the past.