Combined distraction osteogenesis and Papineau technique for an open fracture management of the distal lower extremity

Papineau-irrigation technique: an alternative treatment of fracture-related infectious soft tissue defects

The original Papineau technique described satisfactory results in treating infection-related pseudarthrosis and chronic osteomyelitis with chronic draining wounds. We described our experience in treating these soft tissue defects using the Papineau-irrigation technique. We retrospectively reviewed the records of patients that were treated with the Papineau-irrigation technique at UZ Leuven, Belgium, between January 2006 and January 2023. All surgical procedures were performed by one senior orthopedic surgeon. There were no exclusion criteria. There was successful healing of the soft tissue defect in 27 out of 32 patients with serial drip irrigation. Additional debridement was often necessary. The Papineau-irrigation technique may provide a useful alternative for treating fracture-related soft tissue defects. In addition, this technique is safe and feasible. Further comparative studies are necessary to validate its efficacy.

Reconstruction of tibial bone defect in new age using the old age Papineau technique: A case series

Introduction

Despite advances in treatment, chronic osteomyelitis and infected nonunion after trauma remain a challenge to the orthopaedic field. The Papineau technique, firstly described in 1973, is an alternative to treat such conditions in hospitals where microsurgery is not available, making closure of defect using flap is not feasible. We described our experience in treating patients with chronic osteomyelitis and infected non-union of tibial fractures using the Papineau technique.

Methods

We reviewed the records of patients with severe open tibial fractures with bone defects who were treated using the Papineau technique at Cipto Mangunkusumo Hospital, Jakarta, Indonesia during the period of January 2017 to August 2019. Those with diabetes mellitus, severe liver disease, or malignancies were excluded. All surgical procedures were performed by one senior orthopedic surgeon.

Results

A total of four subjects were enrolled in this study. All subjects were male, with a mean age of 29 ± 6.16 years of age. The mean time to granulation tissue was 21.5 ± 1.29 days, and the mean time to union was 6 ± 0 months. There were no complications.

Conclusions

The Papineau technique may provide successful eradication of infection, reconstruction of bone defect, and soft-tissue closure. In addition, this technique is feasible and safe, and it could be performed in small healthcare centres.

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Cases of chronic osteomyelitis and infected nonunion after trauma remain a challenge.

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No consensus regarding the best method.

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In Indonesia studies regarding the use of the Papineau technique never been conducted.

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The Papineau technique could be performed in small healthcare centres.

Effect of vacuum-assisted closure combined with open bone grafting to promote rabbit bone graft vascularization

Background

Patients with composite bone non-union and soft tissue defects are difficult to treat. Vacuum-assisted closure (VAC) combined with open bone grafting is one of the most effective treatments at present. The aim of the present study was to preliminarily investigate the effect and mechanism of VAC combined with open bone grafting to promote rabbit bone graft vascularization, and to propose a theoretical basis for clinical work.

Material/Methods

Twenty-four New Zealand white rabbits were randomly divided into an experimental and a control group. Allogeneic bones were grafted and banded with the proximal femur with a suture. The experimental group had VAC whereas the control group had normal wound closure. The bone vascularization rate was compared based on X-ray imaging, fluorescent bone labeling (labeled tetracycline hydrochloride and calcein), calcium content in the callus, and expression of fibroblast growth factor-2 (FGF-2) in bone allografts by Western blot analysis at the 4^th, 8^th, and 12^th week after surgery.

Results

At the 4^th, 8^th, and 12^th week after surgery, the results of the tests demonstrated that the callus was larger, contained more calcium (p<0.05), and expressed FGF-2 at higher levels (p<0.05) in the experimental group than in the control group. Fluorescent bone labeling showed the distance between the two fluorescent ribbons was significantly shorter in the control group than in the experimental group at the 8^th and 12^th week after surgery.

Conclusions

VAC combined with open bone grafting promoted rabbit bone graft vascularization.

Successful limb salvage using the two-staged technique with internal fixation after osteodistraction in an effort to treat large segmental bone defects in the lower extremity

BACKGROUND

The reconstruction of large segmental bone defects exceeding 8 cm remains a major therapeutic challenge. Strategies to avoid amputation and thereby provide satisfactory functional outcomes have not been sufficiently evaluated. Therefore, the present study reviews the clinical and functional outcomes after limb salvage.

METHODS

From 1994 to 2011, a consecutive series of 12 patients with lower-limb segmental bone loss exceeding 8 cm were reviewed. Eight patients had suffered from a third-degree open fracture, whereas four patients had undergone bone resection after osteomyelitis. All patients underwent initial skeletal fixation with a simple, external frame. In six patients, the bone healed with no further stabilization after osteodistraction, while internal fixation by intramedullary nailing or plating was necessary in six patients.

RESULTS

In reference to the clinical outcome, ten patients returned to their pre-injury activity level despite sustaining a total of 25 complications. Overall, patients with external fixator alone were at higher risk of sequelae (P = 0.014). In comparing the two groups, axis deviation at the lengthening site occurred in three patients without additional internal fixation; the only refracture occurred in this group. Generally, the size of the bone defect after debridement averaged 12.5 cm (range 8-26 cm). The mean distraction period until frame removal was 11 months (range 3.2-16.2 months). The EFI averaged 33.4 days/cm, whereas no significant differences in EFI were found between the groups.

CONCLUSION

We observed a reduced incidence of axial deviation and refracture in patients with large segmental bone defects who underwent an additional internal stabilization after fixation with an external frame. The two-stage technique caused no increase in infectious complications and might therefore be a preferable approach for successful limb salvage in patients suffering from large segmental bone defects exceeding 8 cm with insufficient bone formation during external fixation.

A systematic approach to the failed plastic surgical reconstruction of the diabetic foot

Plastic reconstruction for diabetic foot wounds must be approached carefully and follow sound micro-surgical principles as it relates to the anatomy of the designated flap chosen for coverage. First, the surgeon always needs to evaluate the local and general conditions of the presenting pathology and patient, respectively when considering a flap for reconstruction. The flap that is chosen is based on the vascularity, location, and size of the defect. Salvage of the failed flap and revisional reconstructive procedures are very challenging. Often, adjunctive therapies such as hyperbaric oxygen, negative pressure wound therapy, vasodilators, and/or vascular surgery is required. In certain case scenarios, such as patients with poor general health and compromised local vascularity in which revisional flap coverage cannot be performed, the above mentioned adjunctive therapies could be used as a primary treatment to potentially salvage a failing flap.