{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T13:34:43Z","timestamp":1785332083517,"version":"3.55.0"},"reference-count":24,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>The role of soft tissue reconstruction in infection control of knee periprosthetic joint infection (PJI) treated with a two-stage exchange strategy remains controversial. This retrospective observational study analysed consecutive patients with chronic knee PJI managed with a two-stage protocol between 2010 and 2023, comparing outcomes between cases requiring flap-based soft tissue reconstruction and those achieving primary closure. A total of 118 patients with a minimum follow-up of 24 months were included. Forty patients (33.9%) required soft tissue reconstruction (STR), including 25 pedicled medial gastrocnemius flaps and 15 anterolateral thigh (ALT) microsurgical free flaps. Patients requiring STR showed greater baseline complexity, with a higher number of previous surgical procedures (3.03 vs. 2.08; p = 0.0057) and a higher prevalence of diabetes mellitus and sinus tracts. Despite this, infection control was superior compared with non-reconstructed cases (100% vs. 88.5%; p = 0.029). Within the STR group, both pedicled and microsurgical techniques achieved complete infection eradication; however, ALT flaps were associated with higher complication rates (46.7%), with partial flap necrosis being the most frequent event. The use of microsurgical reconstruction increased progressively over time, reflecting growing reconstructive complexity. Formal soft tissue reconstruction does not compromise and may facilitate infection control within a multidisciplinary pathway.<\/jats:p>","DOI":"10.3390\/microorganisms14030682","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T07:35:08Z","timestamp":1773819308000},"page":"682","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Soft Tissue Reconstruction Does Not Compromise Infection Control in Chronic Knee Periprosthetic Joint Infection Treated with Two-Stage Exchange Arthroplasty Despite Increasing Complexity"],"prefix":"10.3390","volume":"14","author":[{"given":"Carlos","family":"Mendoza Aguil\u00f3","sequence":"first","affiliation":[{"name":"Orthopaedic Surgery Department, Vall d\u2019Hebron University Hospital, Universitat Aut\u00f2noma de Barcelona (UAB), 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mat\u00edas","family":"Vicente","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery Department, Vall d\u2019Hebron University Hospital, Universitat Aut\u00f2noma de Barcelona (UAB), 08035 Barcelona, Spain"},{"name":"Department of Surgery, Universitat Aut\u00f2noma de Barcelona (UAB), 08035 Barcelona, Spain"},{"name":"Septic and Reconstructive Surgery Unit (UCSO), Orthopaedic Surgery Department, Vall d\u2019Hebron University Hospital, 08035 Barcelona, Spain"},{"name":"Musculoskeletal Tissue Engineering Group, Vall d\u2019Hebron Institute Research, Vall d\u2019Hebron University Hospital, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Cano","sequence":"additional","affiliation":[{"name":"Septic and Reconstructive Surgery Unit (UCSO), Orthopaedic Surgery Department, Vall d\u2019Hebron University Hospital, 08035 Barcelona, Spain"},{"name":"Musculoskeletal Tissue Engineering Group, Vall d\u2019Hebron Institute Research, Vall d\u2019Hebron University Hospital, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2756-8275","authenticated-orcid":false,"given":"Jos\u00e9 Antonio","family":"L\u00f3pez Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery and Major Burn, Vall d\u2019Hebron University Hospital, Universitat Aut\u00f2noma de Barcelona (UAB), 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Bulla","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery and Major Burn, Vall d\u2019Hebron University Hospital, Universitat Aut\u00f2noma de Barcelona (UAB), 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3057-0595","authenticated-orcid":false,"given":"Carles","family":"Amat","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery Department, Vall d\u2019Hebron University Hospital, Universitat Aut\u00f2noma de Barcelona (UAB), 08035 Barcelona, Spain"},{"name":"Department of Surgery, Universitat Aut\u00f2noma de Barcelona (UAB), 08035 Barcelona, Spain"},{"name":"Septic and Reconstructive Surgery Unit (UCSO), Orthopaedic Surgery Department, Vall d\u2019Hebron University Hospital, 08035 Barcelona, Spain"},{"name":"Musculoskeletal Tissue Engineering Group, Vall d\u2019Hebron Institute Research, Vall d\u2019Hebron University Hospital, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3268-6361","authenticated-orcid":false,"given":"Jordi","family":"Serracanta","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery and Major Burn, Vall d\u2019Hebron University Hospital, Universitat Aut\u00f2noma de Barcelona (UAB), 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo S.","family":"Corona","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery Department, Vall d\u2019Hebron University Hospital, Universitat Aut\u00f2noma de Barcelona (UAB), 08035 Barcelona, Spain"},{"name":"Department of Surgery, Universitat Aut\u00f2noma de Barcelona (UAB), 08035 Barcelona, Spain"},{"name":"Septic and Reconstructive Surgery Unit (UCSO), Orthopaedic Surgery Department, Vall d\u2019Hebron University Hospital, 08035 Barcelona, Spain"},{"name":"Musculoskeletal Tissue Engineering Group, Vall d\u2019Hebron Institute Research, Vall d\u2019Hebron University Hospital, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1186\/s13018-024-05384-6","article-title":"Comparative Efficacy and Safety of Bicompartmental versus Total Knee Arthroplasty: A Systematic Review and Update Meta-Analysis","volume":"20","author":"Zhang","year":"2025","journal-title":"J. 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