PMC7298546_01
Knee of the patient with wound healing disorder (A) and x-ray images after primary total knee endoprosthesis implantation (B).
gr1.jpg
PMC7298546_01_gr1.jpg
fig0005
Care University Hospital for a presumed periprosthetic joint infection (Fig. 1). On admission, white blood cell count was normal, C-reactive protein was elevated (167 mg/dl), phosphate was reduced (0.32 mmol/l) and calcium was normal (2.36 mmol/l). The patient's comorbidities included metabolic syndrome with type 2 diabetes mellitus accompanied by micro- and macrovascular complications. Chronic kidney disease was classified stage "G5" (kidney failure, GFR 9 mL/min, KDIGO) without haemodialysis.
Necrosis of the edge of the wound 8 days after gastrocnemius muscular flap (A); local findings of the knee joint post mortem showing extensive skin and soft tissue necrosis (B), high-grade vascular wall sclerosis of the medium and small vessels (C*); histological verification of small vessel calcification (von Kossa staining; D).
gr2.jpg
PMC7298546_01_gr2.jpg
fig0010
Unfortunately, flap necrosis developed after 8 days (Fig. 2A) and additional necrotic lesions occurred on the contralateral lower extremity after 15 days.