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September 2, 2018
I have a difficult case I seek advice on. In March 2018, a total knee ...
read more ↘ arthroplasty was done on this patient. After short hospitalization she was transferred to a short-term facility for further recovery. On the first night there she fell rupturing her patellar tendon off the tibial tubercle. The wound developed a hematoma at that area and started to leak. She was taken to the OR to clean the wound and re-suture, and it appeared to be successful, although the patellar tendon was left alone for a secondary procedure. She fell at the facility once again a week later, opening up the wound again, and this time not being so lucky. A deep infection developed, ex-plantation was needed, spacers put in, and wound VAC’s employed to trying get the wound to start to heal. Eventually, the wound granulated and has healed at this point and it is time for reimplantation and reconstruction of the patellar mechanism. My worry is that I don’t feel an incision should be made through the area that had difficulty healing, seen in the accompanying photo.
What kind of incision could be made as an alternative? To the usual incision, and would it be safe to take off diagonally in the incision at the level of the patella?
↖ read less
read more ↘ arthroplasty was done on this patient. After short hospitalization she was transferred to a short-term facility for further recovery. On the first night there she fell rupturing her patellar tendon off the tibial tubercle. The wound developed a hematoma at that area and started to leak. She was taken to the OR to clean the wound and re-suture, and it appeared to be successful, although the patellar tendon was left alone for a secondary procedure. She fell at the facility once again a week later, opening up the wound again, and this time not being so lucky. A deep infection developed, ex-plantation was needed, spacers put in, and wound VAC’s employed to trying get the wound to start to heal. Eventually, the wound granulated and has healed at this point and it is time for reimplantation and reconstruction of the patellar mechanism. My worry is that I don’t feel an incision should be made through the area that had difficulty healing, seen in the accompanying photo.
What kind of incision could be made as an alternative? To the usual incision, and would it be safe to take off diagonally in the incision at the level of the patella?
↖ read less
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