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Prophylactic Free Flap for Chronic Lower-Extremity Soft-Tissue Defect Prior to Total Knee ArthroplastyA Case Report
Dane C. Hansen, DO1; Wong K. Moon, MD2; Sharat K. Kusuma, MD, MBA2
1 Department of Orthopaedic Surgery, Doctors Hospital Medical Education, 5100 West Broad Street, Columbus, OH 43228. E-mail address: danechansendo@gmail.com
2 Department of Plastic Surgery (W.K.M.), Department of Orthopaedic Surgery (S.K.K.), Grant Medical Center, 393 East Town Street, Columbus, OH 43215
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Investigation performed at Grant Medical Center, Columbus, Ohio

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2013 Jul 24;3(3):e75 1-6. doi: 10.2106/JBJS.CC.M.00005
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Attempting total knee arthroplasty in patients with preoperative periarticular soft-tissue defects can result in disastrous postoperative complications. Orthopaedic surgeons often fail to appropriately evaluate and plan the management of these skin defects, which can lead to skin sloughing, necrosis, exposed total knee arthroplasty hardware, and the need for additional intervention. As expected, the results from salvage soft-tissue protocols are mixed1-9. Salvage soft-tissue procedures are undertaken in the setting of well-fixed total knee arthroplasty hardware and a compromised soft-tissue envelope rather than in the preoperative state. Infection risk is substantially higher once hardware has been placed, and the results are often poor with regard to functional rehabilitation and recovery10,11.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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