Wound Coverage Options for Soft Tissue Defects Following Calcaneal Fracture Management (Operative/Surgical)

Development of a nomogram to predict surgical site infection after closed comminuted calcaneal fracture

Background

Compared with open comminuted calcaneal fractures, less emphasis is placed on postoperative surgical site infection (SSI) of closed comminuted calcaneal fractures. This study aimed to identify the risk factors associated with SSI and build a nomogram model to visualize the risk factors for postoperative SSI.

Methods

We retrospectively collected patients with closed comminuted calcaneal fractures from the Second Affiliated Hospital of Wenzhou Medical University database from 2017 to 2020. Risk factors were identified by logistics regression analysis, and the predictive value of risk factors was evaluated by ROC (receiver operating characteristic curve). Besides, the final risk factors were incorporated into R4.1.2 software to establish a visual nomogram prediction model.

Results

The high-fall injury, operative time, prealbumin, aspartate aminotransferase (AST), and cystatin-C were independent predictors of SSI in calcaneal fracture patients, with OR values of 5.565 (95%CI 2.220–13.951), 1.044 (95%CI 1.023–1.064), 0.988 (95%CI 0.980–0.995), 1.035 (95%CI 1.004–1.067) and 0.010 (95%CI 0.001–0.185) (P_s < 0.05). Furthermore, ROC curve analysis showed that the AUC values of high-fall injury, operation time, prealbumin, AST, cystatin-C, and their composite indicator for predicting SSI were 0.680 (95%CI 0.593–0.766), 0.756 (95%CI 0.672–939), 0.331 (95%CI 0.243–0.419), 0.605 (95%CI 0.512–0.698), 0.319 (95%CI 0.226–0.413) and 0.860 (95%CI 0.794–0.926), respectively (P_s < 0.05). Moreover, the accuracy of the nomogram to predict SSI risk was 0.860.

Conclusions

Our study findings suggest that clinicians should pay more attention to the preoperative prealbumin, AST, cystatin C, high-fall injury, and operative time for patients with closed comminuting calcaneal fractures to avoid the occurrence of postoperative SSI. Furthermore, our established nomogram to assess the risk of SSI in calcaneal fracture patients yielded good accuracy and can assist clinicians in taking appropriate measures to prevent SSI.

A nomogram for predicting post-operative wound complications after open reduction and internal fixation for calcaneal fractures

The purpose of our study was to determine the risk factors for post-operative wound complications (PWCs) after open reduction and internal fixation (ORIF) for calcaneal fracture and establish a nomogram prediction model. We retrospectively analysed the clinical data of patients who suffered from calcaneal fractures and had been surgically treated for ORIF in our institution between January 2010 and January 2020. Perioperative information was obtained through the electronic medical record system, univariate and multivariate analyses were performed to determine the risk factors of PWCs, and a nomogram model was constructed to predict the risk of PWCs. The predictive performance and consistency of the model were evaluated by the Hosmer -Lemeshow (H-L) test and the calibration curve. In total, 444 patients were enrolled in our study. Multivariate analysis results showed that smoking, limb swelling, angle of incision, and CRP were independent risk factors for skin necrosis. The AUC value for skin necrosis risk was 0.982 (95%CI 0.97-0.99). The H-L test revealed that the normogram prediction model had good calibration ability (P = .957). Finally, we found a correlation between PWCs and smoking, limb swelling, angle of incision, and CRP after ORIF for calcaneal fracture patients. Our nomogram prediction model might be helpful for clinicians to identify high-risk patients, as interventions could be taken early to reduce the incidence of PWCs.

Surgical Treatment of Diabetic Foot and Ankle Osteomyelitis

A review of the literature regarding the evaluation and management of osteomyelitis and discussion on clinical, radiographic, laboratory, and pathologic findings with both acute and chronic cases is presented. Cases illustrate the complexities that can typically present at an academic setting, which often require a stepwise approach and interdisciplinary collaboration. Surgical pearls and ancillary treatment of osteomyelitis highlight the technical challenges and surgeons' preferences.

Local Random Pattern Flap Coverage for Implant Exposure following Open Reduction Internal Fixation via Extensile Lateral Approach to the Calcaneus

Background

Skin necrosis and implant exposure most often appear at the corner of Extensile Lateral Approach for open reduction and internal fixation (ORIF) for displaced intra-articular fracture of the calcaneus. Flap transfer is often used for coverage of this implant exposure. We introduced a new simple local random pattern flap to cover the implant exposure.

Methods

From March 2017 to March 2020, 12 patients with implant exposure after ORIF for displaced intra-articular fracture of the calcaneus were treated with this procedure. The sizes of the defects ranged from 2 × 2 cm² to 5 × 2 cm². A local random pattern flap was designed according to the defect size. The lower edge of the flap was along with the wound upper edge and extended distally. The upper horizontal incision of the flap was made at the lateral malleolus level with a length of 5–7 cm depending on the wound defect. Then the random pattern flap was elevated and transferred to cover the defect area.

Results

The mean follow-up duration was 6.3 months (ranging 4–13 months). All 12 flaps were uneventfully healed and all patients were able to wear shoes, and no debulking procedures were required.

Conclusion

The local random pattern flap could be a choice for surgeons when implant exposure at the corner of Extensile Lateral Approach to the Calcaneus occurs.

Effect of vacuum sealing drainage on healing time and inflammation-related indicators in patients with soft tissue wounds

The aim of this study was to investigate the therapeutic effects of vacuum sealing drainage (VSD) on wound repair time and inflammation-related indicators in patients with soft-tissue wounds in comparison with traditional treatment. From January 2018 to January 2020, 130 enrolled patients with soft-tissue wounds were randomly divided into two groups: VSD group (65 cases) and routine dressing change (RDC) group (65 cases). The inflammation-related indicators including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cell (WBC), and procalcitonin (PCT) of preoperative stage and postoperative day 3 (POD 3) and POD 7 were recorded. Wound healing was observed 3 and 7 days after treatment, and the clinical efficacy, changes in the wound (coverage rate and thickness of granulation tissue and bacterial clearance rate), wound-cleaning time, wound-healing time, and hospital stay time were recorded after treatment as well. No significant difference was observed in terms of the baseline between the two groups. On POD 3 and POD 7, CRP, WBC, and PCT levels in the VSD group were lower than those in the RDC group, while ESR levels were higher, with significant differences (P < .05). After treatment, the wound-cleaning time, wound-healing time, and hospital length of stay of the VSD group were all lower than those of the RDC group, with significant differences (P < .05). VSD has a significant effect on the treatment of patients with soft-tissue wounds, which can effectively shorten the time of wound healing and reduce inflammation-related indicators. Compared with traditional RDC, VSD is more worthy of clinical application.