Total Patellar Skin Loss From Cryotherapy After Total Knee Arthroplasty

• Published in: The Journal of arthroplasty Vol. 28; no. 2; pp. 376.e5 - 376.e7
• Main Authors: Dundon, John M., MD, Rymer, Michael C., MD, Johnson, Ron M., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2013
• Subjects: Arthroplasty, Replacement, Knee; Bandages; cryotherapy; Cryotherapy - adverse effects; Debridement; Female; Frostbite - etiology; Frostbite - therapy; Humans; Integra; Middle Aged; Negative-Pressure Wound Therapy; Orthopedics; patellar skin loss; skin coverage; Skin Transplantation; Soft Tissue Injuries - surgery; Soft Tissue Injuries - therapy; total knee arthroplasty; Wound Healing; Wounds and Injuries - therapy; total knee arthroplasty; patellar skin loss; cryotherapy; skin coverage; Integra
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2012.05.024

Abstract The use of cryotherapy after total knee arthroplasty is a very common therapeutic adjunct accepted as routine postoperative care. We present 2 cases of total patellar skin loss due to cryotherapy after total knee arthroplasty. Substantial soft tissue defects were created after the initial debridement of the necrotic tissue. Both patients were evaluated for frostbite, and the wounds were sharply debrided. Application of an advanced wound management technique involves the use of a collagen-glycosaminoglycan biodegradable bilayer matrix, silver impregnated antimicrobial dressing, and low-pressure vacuum device, followed by delayed split thickness skin grafting and low-pressure vacuum device. We find that this technique provided durable soft tissue coverage for necrotic wounds of the knee that do not involve the joint capsule.