Salvage of the exposed irradiated knee joint with free tissue transfer

Extremity radiation results in substantial complications in 6% to 10% of pa tients and includes fracture, edema, pain, fibrosis, neuropathy, arterial t hrombosis, joint immobility, soft-tissue necrosis, and chronic infection. C hronic ulceration and infection of an irradiated joint is considered a part icularly challenging problem for the reconstructive surgeon, and results of surgical management of these complications have not been reported previous ly in the medical literature. Two patients are presented with large ulcerat ed and necrotic radiation wounds of the knee, with chronic contamination, o steomyelitis, and involvement of the joint space. Both patients were treate d successfully with debridement and coverage with free tissue transfer. The y obtained stable, healed wounds, became pain free, and were able to ambula te on long-term follow-up. Adherence to principles established previously f or the management of radiation-induced ulcers on other parts of the body no t involving joint spaces (namely, thorough wound debridement and coverage w ith nonirradiated, well-vascularized tissue) can allow successful extremity salvage even in the presence of joint exposure, contamination, and osteomy elitis.