Wound healing in total joint arthroplasty.
Identifieur interne : 005518 ( Main/Exploration ); précédent : 005517; suivant : 005519Wound healing in total joint arthroplasty.
Auteurs : Richard E. Jones [États-Unis]Source :
- Orthopedics [ 1938-2367 ] ; 2010.
Descripteurs français
- KwdFr :
- MESH :
English descriptors
- KwdEn :
- MESH :
- diagnosis : Postoperative Complications, Prosthesis-Related Infections.
- prevention & control : Prosthesis-Related Infections.
- therapy : Postoperative Complications.
- Arthroplasty, Replacement, Knee, Bandages, Drainage, Humans, Wound Healing.
Abstract
Obtaining primary wound healing in total joint arthroplasty is essential to a good result. Wound healing problems can occur and the consequences can be devastating. Determination of the host healing capacity can be useful in predicting complications. Cierney and Mader classified patients as type A, no healing compromises; and type B, systemic or local healing compromising factors present. Local factors include traumatic arthritis, multiple previous incisions, extensive scarring, lymphedema, poor vascular perfusion. Systemic compromising factors include diabetes, rheumatic diseases, renal or liver disease, immunocompromise, steroids, smoking, and poor nutrition. In high-risk patients, the surgeon should encourage positive choices such as smoking cessation and nutritional supplementation to elevate the total lymphocyte count and total albumin. Careful planning of incisions, particularly in patients with scarring or multiple previous operations, is productive. Around the knee the vascular viability is better in the medial flap. Thus, use the most lateral previous incision, do minimal undermining, and handle tissue meticulously. We perform all potentially complicated total knee arthroplasties without tourniquet to enhance blood flow and tissue viability. The use of perioperative anticoagulation will increase wound problems. If wound drainage or healing problems occur, immediate action is required. Deep sepsis can be ruled out with a joint aspiration and cell count (>2000), differential (>50% polys), and negative culture and sensitivity. All hematomas should be evacuated and necrosis or dehiscence should be managed by debridement to obtain a live wound.
DOI: 10.3928/01477447-20100722-35
PubMed: 20839686
Affiliations:
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Jones</name><affiliation wicri:level="2"><nlm:affiliation>Department Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA. dickeyjones@gmail.com</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Texas</wicri:regionArea><placeName><region type="state">Texas</region></placeName></affiliation></author></analytic><series><title level="j">Orthopedics</title><idno type="eISSN">1938-2367</idno><imprint><date when="2010" type="published">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Arthroplasty, Replacement, Knee</term><term>Bandages</term><term>Drainage</term><term>Humans</term><term>Postoperative Complications (diagnosis)</term><term>Postoperative Complications (therapy)</term><term>Prosthesis-Related Infections (diagnosis)</term><term>Prosthesis-Related Infections (prevention & control)</term><term>Wound Healing</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Arthroplastie prothétique de genou</term><term>Bandages</term><term>Cicatrisation de plaie</term><term>Complications postopératoires ()</term><term>Complications postopératoires (diagnostic)</term><term>Drainage</term><term>Humains</term><term>Infections dues aux prothèses ()</term><term>Infections dues aux prothèses (diagnostic)</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Postoperative Complications</term><term>Prosthesis-Related Infections</term></keywords><keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Complications postopératoires</term><term>Infections dues aux prothèses</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Prosthesis-Related Infections</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Postoperative Complications</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Arthroplasty, Replacement, Knee</term><term>Bandages</term><term>Drainage</term><term>Humans</term><term>Wound Healing</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Arthroplastie prothétique de genou</term><term>Bandages</term><term>Cicatrisation de plaie</term><term>Complications postopératoires</term><term>Drainage</term><term>Humains</term><term>Infections dues aux prothèses</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Obtaining primary wound healing in total joint arthroplasty is essential to a good result. Wound healing problems can occur and the consequences can be devastating. Determination of the host healing capacity can be useful in predicting complications. Cierney and Mader classified patients as type A, no healing compromises; and type B, systemic or local healing compromising factors present. Local factors include traumatic arthritis, multiple previous incisions, extensive scarring, lymphedema, poor vascular perfusion. Systemic compromising factors include diabetes, rheumatic diseases, renal or liver disease, immunocompromise, steroids, smoking, and poor nutrition. In high-risk patients, the surgeon should encourage positive choices such as smoking cessation and nutritional supplementation to elevate the total lymphocyte count and total albumin. Careful planning of incisions, particularly in patients with scarring or multiple previous operations, is productive. Around the knee the vascular viability is better in the medial flap. Thus, use the most lateral previous incision, do minimal undermining, and handle tissue meticulously. We perform all potentially complicated total knee arthroplasties without tourniquet to enhance blood flow and tissue viability. The use of perioperative anticoagulation will increase wound problems. If wound drainage or healing problems occur, immediate action is required. Deep sepsis can be ruled out with a joint aspiration and cell count (>2000), differential (>50% polys), and negative culture and sensitivity. All hematomas should be evacuated and necrosis or dehiscence should be managed by debridement to obtain a live wound.</div></front></TEI><affiliations><list><country><li>États-Unis</li></country><region><li>Texas</li></region></list><tree><country name="États-Unis"><region name="Texas"><name sortKey="Jones, Richard E" sort="Jones, Richard E" uniqKey="Jones R" first="Richard E" last="Jones">Richard E. 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