A Single Tertiary-Care Center Case Series Using Vertical Rectus Abdominis Myocutaneous Flap in the Management of Complex Periprosthetic Joint Infection of the Hip
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design and Ethics
2.2. Patient Classification
2.3. Outcome
2.4. Surgical Technique
2.5. Microbiological Diagnostic Procedures
3. Results
3.1. Patient Characteristics and Surgical History
3.2. Surgical Outcomes, Complications, and Functional Outcome
3.3. Microbiological Findings and Antibiotic Therapy
4. Discussion
Studies | No. of Patients | Flap Type | No. of Polymicrobial | Average Prior PJI Surgeries | Wound Condition | Implant Retention |
---|---|---|---|---|---|---|
Arnold, 1983 [21] | 7 | 6 RF, 3 VL | 7 (78%) | 10.3 (6–25) | Healed | 0 (0%) |
Jones, 1991 [23] | 5 | 3 RA, 1 LD, 1 VL | NA | (4–32) | Healed | 1 (20%) |
Meland, 1991 [13] | 27 | 23 RF, 8 VL, 1 TFL | 27 (84%) | 4.2 (1–21) | Healed | 18 (67%) |
Lewis, 1994 [29] | 1 | TFL | NA | 4 | Healed | 0 (0%) |
Windle, 1996 [26] | 3 | RA | NA | Multiple | Healed | 3 (100%) |
Lee, 1996 [6] | 7 | VL | 2 (29%) | 2.9 (2–5) | Healed | 0 (0%) |
Ross, 1998 [25] | 1 | RA | NA | 4 | Healed | 0 (0%) |
Ikeda, 2001 [30] | 1 | VL | 0 | NA | Healed | 0 (0%) |
Gusenoff, 2002 [20] | 4 | VL | NA | 2.6 (1–5) | Healed | 3 (75%) |
Huang, 2005 [31] | 4 | VL | 2 (50%) | 6 (4–8) | Healed | 2 (50%) |
Shieh, 2007 [8] | 1 | VL | 0 | multiple | Healed | 1 (100%) |
D’Ettorre, 2010 [7] | 2 | VL | 0 | NA | Healed | 2 (100%) |
Suda, 2010 [28] | 119 | VL | 6 (5%) | 4.9 (2–25) | Healed | 4 (3%) |
Choa, 2011 [5] | 24 | 20 RF, 5 VL | 22 (88%) | 4 (1–8) | 22 healed, 2 sinuses | 14 (58%) |
Ricciardi, 2017 [4] | 4 | GM | 4 (100%) | 4.75 (2–8) | Healed | 3 (75%) |
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
VRAM | Vertical rectus abdominis myocutaneous |
PJI | Prosthetic joint infection |
DIEA | Deep inferior epigastric artery |
THA | Total hip arthroplasty |
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Patient | Age | Sex | Ethnicity | Site | BMI | Comorbidities | Smoking | ASA | McPherson Staging System | ||
---|---|---|---|---|---|---|---|---|---|---|---|
Infection Type | Systemic Host Grade | Local Extremity Grade | |||||||||
1 | 80 | F | African | R | 31.4 | HTN, DSLP, CVA, Anemia, GERD | Never | 4 | III | B | 2 |
2 | 78 | F | White | R | 24.7 | HTN, DSLP, Anemia, Mitral and tricuspid regurgitation, osteoporosis | Never | 3 | III | A | 2 |
3 | 65 | F | White | L | 43.4 | HTN, GERD, HNPCC, COPD, Anemia, | Former | 3 | III | A | 2 |
4 | 67 | M | White | L | 30.43 | HTN, CVA, Adrenal gland hypofunction, Hiatal hernia, Asthma, Pseudocholinesterase deficiency. | Marijuana | 3 | III | B | 2 |
5 | 48 | M | White | L | 31.56 | HTN, GERD | Marijuana | 3 | III | B | 2 |
Patient | Surgical Approach | PJI Surgeries Before VRAM | PJI Surgeries After VRAM | Prior Flap Recon | Implant During VRAM |
---|---|---|---|---|---|
1 | Posterior | 2 | 0 | No | Retained |
2 | Posterior | 5 | 0 | GM | Retained |
3 | Anterior | 3 | 5 | GM | Retained |
4 | Posterior | 8 | 0 | TFL | Removed |
5 | Anterior | 3 | 0 | No | Removed |
Patient | Follow Up Duration | Complication | Clavien-Dindo Classification | Flap Condition | Wound Condition | Chronic Suppression | Implant | Function |
---|---|---|---|---|---|---|---|---|
1 | 24 M | Graft edge necrosis, Donor site dehiscence, Ventral hernia, seroma | II, IIIa | Viable | Draining sinus | none | Retained | Ambulating with walker |
2 | 12 M | Ventral hernia | I | Viable | Healed | Abx | Retained | Ambulating with walker |
3 | 47 M | Graft edge necrosis, Donor site dehiscence | II | Viable | Healed | none | Retained | Ambulating with walker |
4 | 40 M | Donor site dehiscence. | II, IIIa | Viable | Healed | Abx | Retained | Ambulating with walker |
5 | 17 M | Graft site dehiscence | II | Viable | Healed | Abx | Retained | Independent ambulation |
Patient | PJI Surgeries | Organism(s) Identified | Resistance/Susceptibility Profile | Antibiotic Treatment |
---|---|---|---|---|
1 | 1 | Morganella morganii | R—Amoxicillin/Clavulanate, Ampicillin, Cefazolin, Ceftriaxone S—Ciprofloxacin, Gentamicin, Piperacillin/Tazobactam, TMP/SMX, Tobramycin | Piperacillin/Tazobactam, Meropenem |
Pseudomonas aeruginosa | S—Ceftazidime, Meropenem, Piperacillin/Tazobactam, TMP/SMX, Tobramycin | |||
2 | Vancomycin-resistant Enterococcus (VRE) | R—Ampicillin, Tetracycline, Vancomycin S—Daptomycin, Linezolid | Daptomycin, Meropenem | |
VRAM | Corynebacterium striatum | R—Ciprofloxacin, Erythromycin, Penicillin, Tetracycline I—Gentamicin S—Linezolid, Vancomycin | Meropenem, Daptomycin | |
2 | 1 | No growth | N/A | Cefazolin |
2 | No growth | N/A | Cefazolin, Vancomycin | |
3 | No growth | N/A | Vancomycin, Ceftriaxone | |
4 | Coagulase-negative Staph aureus | S—Cefazolin, Cloxacillin, Rifampin, TMP/SMX | Cefazolin | |
5 | Staph. epidermidis | R—Cefazolin, Ciprofloxacin, Clindamycin, Eloxacillin, erythromycin, Levofloxacin, Tetracycline, TMP/SMX S—Rifampin, Vancomycin | Daptomycin, Doxycycline | |
VRAM | Staph. epidermidis | R—Cefazolin, Cloxacillin, TMP/SMX S—Rifampin, Vancomycin | Ciprofloxacin, Daptomycin, Rifampin | |
3 | 1 | Enterococcus faecalis | S—Ampicillin | Ampicillin, Metronidazole |
Prevotella bivia | S—Metronidazole, Amoxicillin/Clavulanate, Piperacillin/Tazobactam, Carbapenems | |||
2 | Klebsiella pneumoniae | R—Ampicillin S—Ciprofloxacin, Gentamycin, Cefazolin, TMP/SMX, Tobramycin | Ampicillin, Meropenem | |
Pseudomonas aeruginosa | S—Ceftazidime, Ciprofloxacin, Gentamycin, Piperacillin/Tazobactam, Meropenem, Tobramycin | |||
Citrobacter freundii complex | R—Amoxicillin/Clavulanate, Ampicillin, Cefazolin, Ceftriaxone S—Ciprofloxacin, Gentamycin, Piperacillin/Tazobactam, TMP/SMX, Tobramycin | |||
3 | Same as above | |||
VRAM | Coryneform bacteria | Not specified | Ampicillin, Meropenem | |
1 | Corynebacterium striatum | R—Ciprofloxacin, Erythromycin, Gentamicin, Penicillin, TMP/SMX S—Linezolid, Vancomycin | Ciprofloxacin | |
2 | Corynebacterium striatum | Same as above | Ciprofloxacin, Meropenem | |
3 | Candida albicans | S—Fluconazole | Ciprofloxacin, Fluconazole | |
4 | Serratia marcescens | R—Amoxicillin/Clavulanate, Ampicillin, Cefazolin, Ceftriaxone, Ciprofloxacin. I—TMP/SMX S—Gentamycin, Meropenem, Pipercillin/Tazobactam, Tobramycin | Meropenem, Fluconazole | |
VRE faecium | S—Ampicillin | |||
Candida albicans | ||||
5 | VRE faecium | S—Ampicillin | Meropenem, Fluconazole | |
4 | 1 | MRSA | No sensitivity data (external facility) | Vancomycin |
2 | MRSA, Enterococcus faecalis | No sensitivity data (external facility) | Vancomycin, Ertapenem | |
3 | MRSA, Enterococcus faecalis, Serratia | No sensitivity data (external facility) | Vancomycin, Ertapenem, Daptomycin | |
4 | Candida albicans | Not specified | Meropenem, Daptomycin | |
5 | Candida albicans | Not specified | Meropenem, Daptomycin, Fluconazole | |
6 | No growth | N/A | Meropenem, Daptomycin, Fluconazole | |
7 | No growth | N/A | Meropenem, Daptomycin, Fluconazole | |
8 | No growth | N/A | Meropenem, Daptomycin, Fluconazole | |
VRAM | No growth | N/A | Moxifloxacin, Daptomycin | |
5 | 1 | Pseudomonas aeruginosa | S—Ceftriaxone, Ciprofloxacin, Gentamicin, Meropenem, Piperacillin/Tazobactam, Tobramycin | Ceftazidime, Ciprofloxacin |
2 | No growth | N/A | Ceftazidime, Ciprofloxacin | |
3 | VRE faecium | R—Vancomycin, Ampicillin S—Daptomycin, Linezolid | Daptomycin, Ciprofloxacin | |
VRAM | No growth | N/A | Daptomycin, Ciprofloxacin |
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Salem, O.; Zhang, J.; Grammatopoulos, G.; Garceau, S.; Abdelbary, H. A Single Tertiary-Care Center Case Series Using Vertical Rectus Abdominis Myocutaneous Flap in the Management of Complex Periprosthetic Joint Infection of the Hip. Microorganisms 2025, 13, 1962. https://doi.org/10.3390/microorganisms13081962
Salem O, Zhang J, Grammatopoulos G, Garceau S, Abdelbary H. A Single Tertiary-Care Center Case Series Using Vertical Rectus Abdominis Myocutaneous Flap in the Management of Complex Periprosthetic Joint Infection of the Hip. Microorganisms. 2025; 13(8):1962. https://doi.org/10.3390/microorganisms13081962
Chicago/Turabian StyleSalem, Omar, Jing Zhang, George Grammatopoulos, Simon Garceau, and Hesham Abdelbary. 2025. "A Single Tertiary-Care Center Case Series Using Vertical Rectus Abdominis Myocutaneous Flap in the Management of Complex Periprosthetic Joint Infection of the Hip" Microorganisms 13, no. 8: 1962. https://doi.org/10.3390/microorganisms13081962
APA StyleSalem, O., Zhang, J., Grammatopoulos, G., Garceau, S., & Abdelbary, H. (2025). A Single Tertiary-Care Center Case Series Using Vertical Rectus Abdominis Myocutaneous Flap in the Management of Complex Periprosthetic Joint Infection of the Hip. Microorganisms, 13(8), 1962. https://doi.org/10.3390/microorganisms13081962