Exposed endoprosthesis. Management protocol using muscle and myocutaneous flap coverage.

A tenet in the orthopedic community is that dehiscent wounds overlying exposed prostheses should be treated by implant removal and delayed reconstruction. A management protocol using thorough debridement and irrigation and muscle flap coverage was accomplished in four patients with exposed endoprostheses after total arthroplasty or limb salvage surgery. Predisposing factors for late wound dehiscence in the four oncology patients were preoperative radiation and chemotherapy as well as multiple subsequent reoperations. In this study, all four prostheses and extremities were retained without the need for prosthetic removal or exchange. No infections developed. Late aseptic wound dehiscence with exposed conventional or tumor endoprosthesis need not be managed with prosthetic removal, arthrodesis, or amputation. This one-stage procedure avoided infection, allowed early mobilization, shortened hospitalization and, most important, avoided amputations.