Simultaneous Infection Control and Reconstruction Using Continuous Local Antibiotic Perfusion in Septic Knee With Extensive Soft Tissue Defect: A Case Report.
Yu Fujiwara, Yohei Kumabe, Kenichi Sawauchi et al.
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Case in brief
A 69-year-old woman presented 2.5 months after patellar fracture fixation with methicillin-resistant Staphylococcus aureus infection, septic knee arthritis, and a 12×8 cm anterior soft tissue defect with joint exposure. She underwent total patellectomy, extensive debridement, and continuous local antibiotic perfusion (CLAP). CLAP was continued during reconstruction with a gastrocnemius muscle flap and split-thickness skin grafting 1 week later. Coverage was achieved 17 days after referral, and inflammatory markers normalized within 3 weeks. At 2 years, infection had not recurred; she walked full weight-bearing with a knee extension orthosis and cane.
What made this case unusual
In this salvage case, CLAP was maintained while early flap reconstruction proceeded, allowing infection management and soft tissue coverage to occur in parallel despite septic arthritis and extensive joint-exposing tissue loss.
Diagnostic / clinical pearl
In selected cases of septic knee arthritis with extensive soft tissue loss, CLAP combined with aggressive source control and early flap coverage may permit infection management and reconstruction to proceed concurrently; this single case cannot establish the contribution of each component.