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Alizade C, Aliyev H, Alizada F. The Concept of Treatment for Surgical Infection in the Hindfoot. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241241058. [PMID: 38623152 PMCID: PMC11017820 DOI: 10.1177/24730114241241058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Abstract
Background Chronic osteomyelitis of the calcaneus (OC) and open infected calcaneal fractures, especially when complicated by infected soft tissue defects, present significant surgical challenges. Accepted recommendations for the surgical treatment of this pathology are yet to be established. Methods Drawing from our experience and the consensus among experts, we have developed a concept for selecting optimal, well-known surgical approaches based on the specific pathologic presentation. This concept distinguishes 4 main forms of hindfoot infection: infected wounds, open infected fractures, OC, and their mixed forms. Patients with conditions that could confound the treatment outcomes, such as diabetes mellitus and neurotrophic diseases, were excluded from this analysis. We present a retrospective analysis of the treatment outcomes for 44 patients (4 women and 40 men) treated between 2009 and 2022 using some refined surgical techniques. Treatment success was evaluated based on the absence of disease recurrence within a 2-year follow-up, the avoidance of below-knee amputations, and the restoration of weightbearing function. Results The treatment results were considered through the prism of our proposed concept and according to the Cierny-Mader classification. There were 4 instances of disease recurrence, necessitating 6 additional surgeries, 2 of which (4.5% of the patient cohort) resulted in amputations. In the remaining cases, we were able to restore weightbearing function and eliminate the infection through reconstructive surgeries, employing skin grafts when necessary. Conclusion Surgical infections of the hindfoot area remain a significant challenge. The strategic concept we propose for surgical decision making, tailored to the specific pathology, represents a potential advancement in addressing this challenge. This framework could provide valuable guidance for orthopaedic surgeons in their clinical decision-making process. Level of Evidence Level IV, case series.
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Affiliation(s)
| | - Huseyn Aliyev
- Azerbaijan Scientific Research Institute of Traumatology and Orthopedics, Baku, Azerbaijan
| | - Farhad Alizada
- Klinikum am Gesundbrunnen (SLK-Kliniken Heilbronn GmbH), Am Gesundbrunnen 20-26, 74078 Heilbronn
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2
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Yammine K, Alqaysi B, Mansour J, Otayek J, Daher J, Assi C. Gentamicin-permeated cement to sustain mechanical support for the treatment of a chronic calcaneal abscess. A case report. Int J Surg Case Rep 2023; 111:108846. [PMID: 37729823 PMCID: PMC10514422 DOI: 10.1016/j.ijscr.2023.108846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Chronic calcaneal osteomyelitis is a challenging condition associated with high relapse rates, requiring a multidisciplinary approach and various therapeutic options for effective management. We report a very rare case of a pyogenic osteomyelitis of the os calcis presented as a bone abscess. CASE PRESENTATION A diabetic male patient presented with chronic osteomyelitis of the calcaneus in the form of bone abscess with a cavity of 6*5 cm. After pus evacuation and debridement of the cavity, gentamycin-impregnated polymethylmethacrylate cement was used to locally assist in controlling the infection and to assure mechanical support. Antibiogram-based oral antibiotic was administrated for 6 weeks. At final follow-up, the patient could walk without any assistance and was able to raise his body on the operated heel, with no signs of infection. CLINICAL DISCUSSION This case illustrates successful conservative surgical treatment of calcaneal abscess using antibiotic-impregnated cement for mechanical support and local infection control. CONCLUSION Incorporating antibiotic-impregnated cement into conservative foot surgeries for deeply embedded calcaneal abscesses provides effective infection control, mechanical support, and functional preservation, leading to successful treatment outcomes.
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Affiliation(s)
- Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon; Diabetic Foot Clinic, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon; Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Lebanon.
| | - Bilal Alqaysi
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon
| | - Jad Mansour
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon; Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Lebanon
| | - Joeffroy Otayek
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon
| | - Jimmy Daher
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon; Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Lebanon
| | - Chahine Assi
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon; Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Lebanon
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3
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Marei AE, Nada AA, El-Rosasy MA, Helal AS. Recurrent heel ulcers with calcaneal osteomyelitis in myelomeningocele: Treatment by partial calcanectomy and posterior transfer of tibialis anterior tendon. Foot Ankle Surg 2023; 29:44-49. [PMID: 36167760 DOI: 10.1016/j.fas.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/17/2022] [Accepted: 09/08/2022] [Indexed: 02/04/2023]
Abstract
OVERVIEW Calcaneus deformity of the foot is common in patients with myelodysplasia, mainly due to muscle imbalance. This deformity, especially in ambulatory patients, can result in gait problems and development of pressure sores, which can be complicated by calcaneal osteomyelitis. MATERIAL AND METHODS This retrospective cross-sectional study included 12 patients (18 feet), with calcaneus deformity due to myelomeningocele, and presented with penetrating heel ulcers complicated by calcaneal osteomyelitis. The mean age of the included cases was 11 years. The ulcers were unilateral in six patients and bilateral in six. Sensation was absent on the plantar aspect of the foot in all cases. The treatment was done in two stages; The first stage was eradication of infection and obtaining good soft tissue coverage, and the second stage was obtaining motor balance to achieve a more plantigrade and braceable foot. RESULTS The average follow-up period was 19.2 months. In the final follow-up, twelve feet were graded as good, five as fair and one as poor according to Legaspi grading system. CONCLUSION The combination of partial calcanectomy and subsequent transfer of tibialis anterior tendon, to improve the foot position and gait, can efficiently prevent ulcer recurrence in myelomeningocele patients with calcaneal deformity. LEVEL OF CLINICAL EVIDENCE 4: Retrospective case series study.
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Affiliation(s)
- Abdelhakim E Marei
- Department of Orthopaedics, Tanta School of Medicine, Tanta University, Egypt
| | - Abdullah A Nada
- Department of Orthopaedics, Tanta School of Medicine, Tanta University, Egypt.
| | - Mahmoud A El-Rosasy
- Department of Orthopaedics, Tanta School of Medicine, Tanta University, Egypt
| | - Ahmed S Helal
- Department of Orthopaedics, Tanta School of Medicine, Tanta University, Egypt
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Cook HR, Cates NK, Kennedy CJ, Tefera E, Popovsky D, Delijani K, Kim PJ, Attinger CE, Steinberg JS. Risks Factors Associated With Major Lower Extremity Amputation After Vertical Contour Calcanectomy. J Foot Ankle Surg 2022; 61:1046-1051. [PMID: 35168902 DOI: 10.1053/j.jfas.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/22/2020] [Accepted: 01/10/2022] [Indexed: 02/03/2023]
Abstract
The primary aim of the study is to determine risks for major lower extremity amputation after undergoing Vertical Contour Calcanectomy. Subanalysis was performed comparing patients who underwent Vertical Contour Calcanectomy who were fully ambulatory to those who were partially or nonambulatory postoperatively. Within the cohort of 63 patients included in the Vertical Contour Calcanectomy 85.71% (54/63) of patients had diabetes mellitus, 53.97% (34/63) had peripheral arterial disease, and 19.05% (12/63) had Charcot Neuroarthropathy. Multivariate logistic regression, found that (1) patients that underwent primary closure at the time of the Vertical Contour Calcanectomy, were 79.9% more likely (odds ratio [OR] 0.20; 95% confidence interval [CI] 0.04-0.96) to have limb salvage and that (2) female patients were 85.4% less likely compared to male patients (OR 0.15; 95% CI 0.02-0.99) to undergo major lower extremity amputation. Patients with coronary artery disease were 5.2 times more likely (OR 5.18; 95% CI 1.120-23.94) and patients that were nonambulatory preoperatively, were 10.3 times more likely (OR 10.28; 95% CI 1.60-66.26), to be partially or nonambulatory after Vertical Contour Calcanectomy. Primary closure at time of Vertical Contour Calcanectomy significantly decreases the risk of major lower extremity amputation, and diminished preoperative ambulatory status as well as coronary artery disease makes it less likely that patients return to full ambulation after Vertical Contour Calcanectomy.
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Affiliation(s)
- Helene R Cook
- Resident Physician, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington DC
| | - Nicole K Cates
- Limb Preservation and Deformity Correction Fellow, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Christopher J Kennedy
- MedStar Georgetown University Hospital Diabetic Limb Salvage Fellow, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Eshetu Tefera
- Department of Biostatistician and Biomedical Informatics, MedStar Health Research Institute, Washington, DC
| | - Daniel Popovsky
- Medical Student, Georgetown University Medical School, Washington, DC
| | - Kevin Delijani
- Medical Student, Georgetown University Medical School, Washington, DC
| | - Paul J Kim
- Attending Physician, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Christopher E Attinger
- Attending Physician, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - John S Steinberg
- Attending Physician, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC.
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5
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Pereira PF, Silva MR, Simão RS, Negrão P, Sousa A, Neves N. Total calcanectomy in calcaneal osteomyelitis: An alternative to major amputation. Foot (Edinb) 2022; 51:101896. [PMID: 35290842 DOI: 10.1016/j.foot.2021.101896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 10/20/2021] [Accepted: 12/21/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hindfoot ulcers associated with chronic calcaneus osteomyelitis are very difficult to manage and many patients need a limb amputation for resolution. Total calcanectomy can be a salvage procedure for these patients. The purpose of this study is to present our results of total calcanectomy. METHODS Retrospective analysis of six patients undergoing total calcanectomy at our institution between 2008 and 2019. Patient data and ambulatory status were analyzed. RESULTS In 4 of the 6 patients, infection control and wound closure was achieved with total calcanectomy with follow-up ranging from 1 to 12 years. The 4 patients maintain walking ability. Two major complications: an early death caused by a respiratory infection and a below the knee amputation due to recurrence of the foot infection. CONCLUSION Total calcanectomy is an useful procedure for limb salvage in foot ulcers with chronic calcaneus osteomyelitis.
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Affiliation(s)
| | - Manuel Ribeiro Silva
- Orthopedics Department, Centro Hospitalar e Universitário de São João, Porto, Portugal; Surgery and Physiology Department, Faculty of Medicine, University of Porto, Porto, Portugal; CUF Porto Hospital, Porto, Portugal; i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal; INEB - Instituto Nacional de Engenharia Biomédica, University of Porto, Porto, Portugal
| | - Ricardo São Simão
- Orthopedics Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Pedro Negrão
- Orthopedics Department, Centro Hospitalar e Universitário de São João, Porto, Portugal; Surgery and Physiology Department, Faculty of Medicine, University of Porto, Porto, Portugal; CUF Porto Hospital, Porto, Portugal
| | - António Sousa
- Orthopedics Department, Centro Hospitalar e Universitário de São João, Porto, Portugal; Surgery and Physiology Department, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Nuno Neves
- Orthopedics Department, Centro Hospitalar e Universitário de São João, Porto, Portugal; Surgery and Physiology Department, Faculty of Medicine, University of Porto, Porto, Portugal; CUF Porto Hospital, Porto, Portugal; i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal; INEB - Instituto Nacional de Engenharia Biomédica, University of Porto, Porto, Portugal
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6
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Xu L, Song H, Ren Y, Fang J, Zhou C, Zhang H, Meng X, Cheng G, Zhuo R, Qin C. Antibiotic-Impregnated Calcium Sulfate vs. Wound Irrigation-Suction to Treat Chronic Calcaneal Osteomyelitis. Foot Ankle Int 2022; 43:331-342. [PMID: 34719970 DOI: 10.1177/10711007211049768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Chronic osteomyelitis of calcaneus is not rare but is very hard to treat. Irrigation-suction and antibiotic-impregnated calcium sulfate following debridement are commonly used in managing chronic osteomyelitis, but their effects have rarely been compared. We aimed to compare the effectiveness of antibiotic-impregnated calcium sulfate with irrigation-suction in the treatment of patients with chronic calcaneal osteomyelitis. METHODS From January 2011 to June 2018, adult patients at our institute with chronic osteomyelitis receiving treatment of either antibiotic-impregnated calcium sulfate (CS group) or irrigation-suction (IS group) following thorough debridement were screened and selected according to the inclusion and exclusion criteria. The clinical presentation, laboratory tests, complications, and the ultimate single-staged cure rate and recurrence were compared. RESULTS A total of 61 patients, including 41 in the CS group and 20 in the IS group, were included in our study. Of the patients, 85.4% in the CS group and 60.0% in the IS group (P = .006) were successfully cured in the single stage, respectively, without infection recurrence. Lower infection recurrence rates with shorter hospital stay were found in the CS group than the IS group. Inflammatory biomarkers after surgery with both treatments were slightly decreased and not significantly different from preoperative or between-groups postoperative. Exudate from incision was found primarily in the CS group. CONCLUSION This study demonstrates that both antibiotic-impregnated calcium sulfate and irrigation-suction after careful and thorough surgical debridement are generally effective in treating chronic calcaneal osteomyelitis. Antibiotic-impregnated calcium sulfate achieved a higher single-staged cure rate but was associated with an increased postoperative wound exudate. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Lei Xu
- Department of Orthopedics and Traumatology, Guangdong Second Provincial General Hospital, the Second Clinical Medical School of Southern Medical University, 466 Xingang Road C., Haizhu District, Guangzhou, 510317, China
| | - Huijuan Song
- Department of Nursing, Southern Medical University Nanfang Hospital, No.1838, Guangzhou Ave. North, Baiyun District, Guangzhou, China
| | - Ying Ren
- Department of Orthopedics and Traumatology, Guangdong Second Provincial General Hospital, the Second Clinical Medical School of Southern Medical University, 466 Xingang Road C., Haizhu District, Guangzhou, 510317, China.,Department of Nursing, Southern Medical University Nanfang Hospital, No.1838, Guangzhou Ave. North, Baiyun District, Guangzhou, China
| | - Jia Fang
- Department of Orthopedics and Traumatology, Guangdong Second Provincial General Hospital, the Second Clinical Medical School of Southern Medical University, 466 Xingang Road C., Haizhu District, Guangzhou, 510317, China
| | - Chunhao Zhou
- Department of Orthopedics and Traumatology, Guangdong Second Provincial General Hospital, the Second Clinical Medical School of Southern Medical University, 466 Xingang Road C., Haizhu District, Guangzhou, 510317, China
| | - Hongan Zhang
- Department of Orthopedics and Traumatology, Guangdong Second Provincial General Hospital, the Second Clinical Medical School of Southern Medical University, 466 Xingang Road C., Haizhu District, Guangzhou, 510317, China
| | - Xiangqing Meng
- Department of Orthopedics and Traumatology, Guangdong Second Provincial General Hospital, the Second Clinical Medical School of Southern Medical University, 466 Xingang Road C., Haizhu District, Guangzhou, 510317, China
| | - Guoyun Cheng
- Department of Orthopedics and Traumatology, Guangdong Second Provincial General Hospital, the Second Clinical Medical School of Southern Medical University, 466 Xingang Road C., Haizhu District, Guangzhou, 510317, China
| | - Ribo Zhuo
- Department of Orthopedics and Traumatology, Guangdong Second Provincial General Hospital, the Second Clinical Medical School of Southern Medical University, 466 Xingang Road C., Haizhu District, Guangzhou, 510317, China
| | - Chenghe Qin
- Department of Orthopedics and Traumatology, Guangdong Second Provincial General Hospital, the Second Clinical Medical School of Southern Medical University, 466 Xingang Road C., Haizhu District, Guangzhou, 510317, China.,Department of Orthopedics and Traumatology, Southern Medical University Nanfang Hospital, No.1838, Guangzhou Ave. North, Baiyun District, Guangzhou, China
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7
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Torre A, De Monti M. Osteomyelitis of the Calcaneus with Pathologic Fracture. J Foot Ankle Surg 2021; 59:641. [PMID: 32354522 DOI: 10.1053/j.jfas.2019.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 09/19/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Alessandro Torre
- Medical Doctor and Resident in Surgery Servizio di Chirurgia, Ospedale Regionale di Mendrisio, Mendrisio, Switzerland
| | - Marco De Monti
- Medical Doctor, Consultant, ER and General Surgeon, Plastic Reconstructive and Aesthetic Surgeon, Flebologist, Servizio di Chirurgia, Ospedale Regionale di Mendrisio, Mendrisio, Switzerland
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8
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Jiang N, Zhao XQ, Wang L, Lin QR, Hu YJ, Yu B. Single-stage debridement with implantation of antibiotic-loaded calcium sulphate in 34 cases of localized calcaneal osteomyelitis. Acta Orthop 2020; 91:353-359. [PMID: 32237934 PMCID: PMC8023923 DOI: 10.1080/17453674.2020.1745423] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background and purpose - The successful eradication of calcaneus infection with limb salvage remains a challenge. We describe the outcomes of cortical bone windowing followed by eggshell-like debridement and implantation of antibiotic-loaded calcium sulphate (CS) for localized (Cierny-Mader type III) calcaneal osteomyelitis (CO).Patients and methods - We report a retrospective study of 34 patients. Infection followed trauma or orthopedic surgery in 30 patients and hematogenous spread in 4 patients. 31 patients had a sinus tract, accompanied by a soft tissue defect in 3 patients. All patients received cortical bone windowing, debridement, multiple sampling, local implantation of vancomycin- and gentamicin-loaded CS, skin closure or flap coverage, and culture-specific systematic antibiotic treatment in a single-stage procedure. Patients were followed up for a median of 26 months.Results - Infection was eradicated in 29 patients after the single-stage surgery, and all of the 5 recurrent infections were cleared by repeated surgery without amputation. Other adverse events included 11 patients with aseptic wound leakage and 1 unrelated death. Compared with those before surgery, the median postoperative scores of the American Orthopaedic Foot & Ankle Society (AOFAS) ankle hindfoot scale (65 vs. 86 vs. 89) and the visual analog scale (VAS) for pain (6 vs. 3 vs. 1) improved at the 1-year and 2-year follow-up.Interpretation - This single-stage protocol, cortical bone windowing, and eggshell-like debridement combined with local implantation of antibiotic-loaded CS is effective in treating type III CO. However, the incidence of aseptic wound leakage is high.
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Affiliation(s)
- Nan Jiang
- Department of Orthopaedics & Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou; ,Guangdong Provincial Key Laboratory of Bone & Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, P R China
| | - Xing-qi Zhao
- Guangdong Provincial Key Laboratory of Bone & Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, P R China
| | - Lei Wang
- Department of Orthopaedics & Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou;
| | - Qing-rong Lin
- Department of Orthopaedics & Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou;
| | - Yan-jun Hu
- Department of Orthopaedics & Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou;
| | - Bin Yu
- Department of Orthopaedics & Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou; ,Guangdong Provincial Key Laboratory of Bone & Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, P R China,Correspondence:
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9
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Cates NK, Wang K, Stowers JM, Attinger CE, Kim PJ, Steinberg JS. The Vertical Contour Calcanectomy, an Alternative Approach to Surgical Heel Ulcers: A Case Series. J Foot Ankle Surg 2019; 58:1067-1071. [PMID: 31679660 DOI: 10.1053/j.jfas.2019.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 03/31/2019] [Accepted: 04/05/2019] [Indexed: 02/03/2023]
Abstract
Heel ulcers have a significant impact on lower-extremity morbidity and confer high risk of major amputations. Treating these ulcers is difficult because of poor tissue coverage and the bony os calcis, often leading to proximal amputation. This case series shows the vertical contour calcanectomy (VCC) as a surgical alternative in functional limb salvage. Sixteen feet (14 patients) with recalcitrant heel wounds who underwent VCC were identified. The minimum follow-up time for inclusion was 1 year. Body mass index, diabetes, renal disease, peripheral vascular disease, lymphedema/venous insufficiency, smoking status, Charcot, amputation, vascular intervention, wound recurrence, reoperation rate, and ambulatory status were evaluated. The average follow-up time was 27.1 months (range 13.5 to 51.1). At 1 year of follow-up, 56% of heel wounds (9 of 16) treated with the VCC remained closed. An average of 1.44 subsequent surgeries were required per patient. Baseline or improved ambulatory status was achieved in 69% of patients (9 of 14) at 1-year follow up and 100% of patients (8 of 8) at 2-year follow up. The overall rate of major amputation was 19%. The long-term ambulatory status of patients treated with the VCC shows promise. The VCC should be considered as an alternative, reliable, surgical limb salvage tool for heel ulcerations.
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Affiliation(s)
- Nicole K Cates
- Resident Physician, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington DC, USA
| | - Kaihua Wang
- Resident Physician, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington DC, USA
| | - Jered M Stowers
- Resident Physician, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington DC, USA
| | - Christopher E Attinger
- Attending Physician, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Paul J Kim
- Attending Physician, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - John S Steinberg
- Attending Physician, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC, USA.
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10
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Sabater-Martos M, Sigmund IK, Loizou C, McNally M. Surgical Treatment and Outcomes of Calcaneal Osteomyelitis in Adults: A Systematic Review. J Bone Jt Infect 2019; 4:146-154. [PMID: 31192115 PMCID: PMC6536802 DOI: 10.7150/jbji.34452] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 03/23/2019] [Indexed: 01/19/2023] Open
Abstract
Introduction: Calcaneal osteomyelitis is an uncommon and challenging condition. In this systematic review we aim to analyse the outcomes from concomitant use of bone debridement and soft tissue management for patients diagnosed with calcaneal osteomyelitis. Materials & Methods: A complete computerised and comprehensive literature search of Pubmed and Cochrane database was undertaken from January 2000 to October 2018. During the review, studies were screened for information about the surgical and antimicrobial treatment, the complications, the reinfection rate and the functional outcome of patients with calcaneal osteomyelitis. Results: Of the 20 eligible studies included, seven (35%) described bone treatment only, six (30%) soft tissue treatment only, five (25%) soft tissue and bone treatment, and two (10%) focused on prognostic factors and differences in outcomes between diabetic and non-diabetic patients. In the studies with bone treatment only, infection recurrence ranged from 0 to 35% and the amputation rate from 0 to 29%. If soft tissue coverage was also needed, both the reinfection rate and amputation rate ranged from 0 to 24%. Studies presenting the functional status generally showed preservation or even improvement of the preoperative ambulatory status. Conclusion: Calcaneal osteomyelitis is difficult to treat. A multidisciplinary approach involving orthopaedic surgeons, plastic surgeons and infectious disease physicians is preferred. The heterogenicity of studies has hindered the development of agreed treatment protocols, which would be useful in clinical practice.
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Affiliation(s)
- Marta Sabater-Martos
- The Bone Infection Unit, Nuffield Orthopaedic Centre. Windmill Rd, Headington. Oxford OX3 7HE, Oxford University Hospitals Foundation NHS Trust, Oxford, UK.,Department of Orthopaedics and Trauma Surgery. Hospital Universitari Germans Trias i Pujol, Badalona. Carretera del Canyet s/n, 08916 Badalona, Spain
| | - Irene Katharina Sigmund
- The Bone Infection Unit, Nuffield Orthopaedic Centre. Windmill Rd, Headington. Oxford OX3 7HE, Oxford University Hospitals Foundation NHS Trust, Oxford, UK.,Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Spitalgasse 23, 1090 Vienna, Austria
| | - Constantinos Loizou
- The Bone Infection Unit, Nuffield Orthopaedic Centre. Windmill Rd, Headington. Oxford OX3 7HE, Oxford University Hospitals Foundation NHS Trust, Oxford, UK
| | - Martin McNally
- The Bone Infection Unit, Nuffield Orthopaedic Centre. Windmill Rd, Headington. Oxford OX3 7HE, Oxford University Hospitals Foundation NHS Trust, Oxford, UK
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11
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Brucato MP, Wachtler MF, Nasser EM. Osteomyelitis of the Calcaneus With Pathologic Fracture. J Foot Ankle Surg 2019; 58:591-595. [PMID: 30685422 DOI: 10.1053/j.jfas.2018.09.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Indexed: 02/03/2023]
Abstract
Pathologic fractures of the calcaneus secondary to osteomyelitis (OM) have rarely been reported in the literature. This case series describes 5 patients who were treated in our institution for chronic OM of the calcaneus and subsequently suffered a fracture of the involved calcaneus in the absence of trauma. All 5 patients had a history of insulin-dependent diabetes mellitus and were treated with a range of surgical treatments including open reduction and internal fixation, external fixation, and excision of the fracture fragment. Three (60%) of the patients required a below-the-knee amputation of the ipsilateral limb, 1 (20%) expired, and 1 (20%) experienced healing of the fracture and the associated heel wound. Pathologic fracture of the calcaneus secondary to OM is a recognized entity, although case descriptions have rarely been reported for this challenging condition.
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12
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Waibel FWA, Klammer A, Götschi T, Uçkay I, Böni T, Berli MC. Outcome After Surgical Treatment of Calcaneal Osteomyelitis. Foot Ankle Int 2019; 40:562-567. [PMID: 30688528 DOI: 10.1177/1071100718822978] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Surgical procedures for calcaneal osteomyelitis are partial calcanectomy (PC), total calcanectomy (TC), and below-knee amputation (BKA). With calcaneal osteomyelitis, limb-saving surgery was described to have secondary BKA rates of 4% to 20%, while secondary amputation rates after BKA are unknown. The aim of this study was to describe and compare overall revision and secondary amputation rates for each surgical option in our institution's cohort and to identify risk factors for secondary amputation. METHODS Fifty patients treated between 2002 and 2017 were included. Revisions, secondary amputations, and possible risk factors for secondary amputation and overall revision were statistically analyzed. RESULTS Minor revisions rates were 57.1% in PCs, 100% in TCs, and 27.8% in BKAs. Secondary amputation was performed in 28.6% of the PCs, in 50% of the TCs, and in 5.6% of the BKAs. No statistically significant differences between overall revision and secondary amputation rates were found. C-reactive protein values greater than 5 mg/L at the index procedure were significantly associated with overall revision while we could not identify risk factors for secondary amputation. CONCLUSION This study represents the largest group of patients treated for calcaneal osteomyelitis in the literature. In limb-preserving surgical options, secondary BKA rates are higher than previously known. Primary BKA is a procedure with a low reamputation rate of 5.6%. PC can be considered, with 28.6% needing more proximal amputation. In TC, all patients underwent revision surgery and 50% had to undergo secondary BKA. Therefore, we hesitate to consider total calcanectomy as a surgical option in calcaneal osteomyelitis anymore. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Felix W A Waibel
- 1 Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Alexander Klammer
- 1 Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Tobias Götschi
- 2 Department of Orthopaedic Surgery, University of Zurich, Institute for Biomechanics, ETH Zurich, Balgrist Campus, Zurich, Switzerland
| | - Ilker Uçkay
- 3 Unit for Clinical and Applied Research and Infectiology, Balgrist University Hospital, Zurich, Switzerland
| | - Thomas Böni
- 1 Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Martin C Berli
- 1 Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
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Elmarsafi T, Pierre AJ, Wang K, Evans KK, Attinger CE, Kim PJ, Steinberg JS. The Vertical Contour Calcanectomy: An Alternative Surgical Technique to the Conventional Partial Calcanectomy. J Foot Ankle Surg 2019; 58:381-386. [PMID: 30612862 DOI: 10.1053/j.jfas.2018.08.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Indexed: 02/03/2023]
Abstract
Heel ulcers have a significant impact on lower extremity morbidity and confer a high risk for major amputations. Although there are many conservative treatment options, once calcaneal osteomyelitis occurs or a heel ulcer becomes chronic or recalcitrant, more invasive management is required. The partial calcanectomy is a surgical solution that can address both pathologies-the ulceration and the infected bone. The conventional partial calcanectomy, however, does not ensure complete soft tissue closure. Often, closure under tension is required for primary closure of the soft tissue deficit or the wound must be closed by secondary intention. This process occurs, in part, when the proportion of bone resected is insufficient in relation to the size of the wound. Closure under tension increases the possibility of dehiscence and subsequent postoperative surgical site complications that lead to the same risks for major amputation as the index heel ulcer. This article introduces and describes a novel modification to the conventional partial calcanectomy and addresses these aforementioned concerns. The vertical contour calcanectomy incorporates improvements to an already accepted limb salvage technique. The purpose of this article was to describe the indications, contraindications, intraoperative technique and postoperative management of the vertical contour calcanectomy for patients who present with heel ulcers in the limb salvage setting.
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Affiliation(s)
- Tammer Elmarsafi
- Senior Surgeon, Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Andrew J Pierre
- Resident Physician, Division of Podiatric Surgery, MedStar Washington Hospital Center, Washington DC
| | - Kaihua Wang
- Resident Physician, Division of Podiatric Surgery, MedStar Washington Hospital Center, Washington DC
| | - Karen K Evans
- Senior Surgeon, Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Christopher E Attinger
- Senior Surgeon, Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Paul J Kim
- Senior Surgeon, Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - John S Steinberg
- Senior Surgeon, Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC.
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14
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Babiak I, Pędzisz P, Kulig M, Janowicz J, Małdyk P. Comparison of Bone Preserving and Radical Surgical Treatment in 32 Cases of Calcaneal Osteomyelitis. J Bone Jt Infect 2016; 1:10-16. [PMID: 28529846 PMCID: PMC5423567 DOI: 10.7150/jbji.14342] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction. Radical procedures like calcanectomy and amputation performed for calcaneal osteomyelitis are regarded as effective in eradication of infection even though potentially functionally disabling. Bone sparing procedures offer better functional result at the expense of potentially worse infection control. The aim of the study has been to assess the influence of the surgical radicalism as much as the extent of bone infection on the final outcome in the surgical therapy of chronic calcaneal osteomyelitis (CO). Material and method. 32 patients with chronic CO have comprised the group under study: 8 with superficial type, 12 localised type and 12 with diffuse type according to Cierny-Mader classification. The aim of the treatment was to heal infection, preserve the heel shape and achieve good skin coverage over the calcaneus. The therapy consisted of 9 debridement surgeries with or without flaps, 8 drilling-operations of the calcaneus with application of collagen-gentamicin-sponge in bore holes, 15 partial and 2 total calcanectomies, and 4 below-the knee amputations. Results. The healing of infection and wound has been achieved after 7 of 9 debridements, 6 of 8 drilling-operations, 13 of 15 partial and all total calcanectomies. Conclusion. Bone preserving operations in chronic calcaneal osteomyelitis provided inferior infection control (76,47% vs 88,24%) and worse patient satisfaction (88,24% vs 100%) and almost camparable ambulation (100% vs 93,33%). Drilling of the calcaneus with application of collagen sponge containing gentamicin performed in chronic diffuse calcaneal osteomyelitis seems to offer a viable alternative to partial or radical calcanectomy. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Ireneusz Babiak
- Department of Orthopaedics and Traumatology, Medical University of Warsaw, ul. Lindley'a 4, 02-005 Warsaw, Poland
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15
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Kwon JY, Guss D, Lin DE, Abousayed M, Jeng C, Kang S, Ellington JK. Effect of Delay to Definitive Surgical Fixation on Wound Complications in the Treatment of Closed, Intra-articular Calcaneus Fractures. Foot Ankle Int 2015; 36:508-17. [PMID: 25589541 DOI: 10.1177/1071100714565178] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There are conflicting data regarding the benefits of delaying operative fixation of calcaneus fractures to decrease wound complication rates. The purpose of this study was to examine the effect of delaying fixation on wound complication rates as well as to identify other risk factors. METHODS A retrospective review at 4 institutions, including 24 surgeons, identified 405 closed, operatively treated, intra-articular calcaneus fractures. We compared fractures with and without wound complications with regards to patient demographics, medical risk factors, fracture severity, time to fixation, operative approach, primary subtalar arthrodesis, and surgeon experience. RESULTS Wound complications were observed in 21% (87/405) of fractures, of which 33% (29/87) required operative intervention. Male sex (P = .032), smoking (P = .028), and the extensile lateral approach (P < .001) were associated with higher complication rates. Fractures treated with an extensile lateral approach had an overall wound complication rate of 32.1%, while those treated with a sinus tarsi or percutaneous approach had an overall wound complication rate of 8.3% (odds ratio [OR], 5.3; 95% confidence interval [CI], 2.9-9.5; P < .001). Among patients treated with an extensile lateral approach, delayed operative fixation did not decrease wound complication rates despite comparable fracture severity across time points. In contrast, among fractures treated with less invasive approaches, delayed fixation beyond 2 weeks resulted in a significantly increased wound complication rate of 15.2% as compared to a wound complication rate of only 2.1% among fractures treated within a week of injury (OR, 3.2; 95% CI, 1.3-9.5; P = .01). This was observed despite similar fracture severity across time points. Primary subtalar arthrodesis did not impact complication rates. A higher wound complication rate among senior surgeons was likely secondary to their predilection for the extensile lateral approach. CONCLUSION Delaying definitive fixation of closed, intra-articular calcaneus fractures did not decrease wound complication rates when using the extensile lateral approach, and we found an increased wound complication rate when using less invasive approaches. LEVEL OF EVIDENCE Level III, observational study.
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Affiliation(s)
- John Y Kwon
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Daniel Guss
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Darius E Lin
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | - Steve Kang
- University of Southern California, Los Angeles, California, USA
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Oliver NG, Steinberg JS, Powers K, Evans KK, Kim PJ, Attinger CE. Lower extremity function following partial calcanectomy in high-risk limb salvage patients. J Diabetes Res 2015; 2015:432164. [PMID: 25692151 PMCID: PMC4322665 DOI: 10.1155/2015/432164] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 12/31/2014] [Indexed: 11/17/2022] Open
Abstract
Partial calcanectomy (PC) is an established limb salvage procedure for treatment of deep heel ulceration with concomitant calcaneal osteomyelitis. The purpose of this study is to determine if a relationship exists between the amount of calcaneus removed during PC and the resulting lower extremity function and limb salvage outcomes. Consecutive PC patients were retrospectively divided into two cohorts defined by the amount of calcaneus resected before wound closure: patients in cohort 1 retained = 50% of calcaneus, while patients in cohort 2 underwent resection of >50% of the calcaneus. The Lower Extremity Function Scale (LEFS) was used to assess postoperative lower extremity function. The average amount of calcaneus resected was 13% ± 9.2 (1-39%) and 74% ± 19.5 (51-100) in cohorts 1 and 2, respectively (P < 0.0001). Below knee amputation was performed in 7 (28%) and 5 (29%) of subjects in cohorts 1 and 2, respectively (P = 1.0). The average LEFS score was 33.9 ± 15.0 for subjects in cohort 1 and 36.2 ± 19.9 for the subjects cohort 2 (P = 0.8257) which correlates to "moderate to quite a bit of difficulty." Our study suggests that regardless of the amount of calcaneus resected, PC provides a viable treatment option for high-risk patients with calcaneal osteomyelitis.
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Affiliation(s)
- Noah G. Oliver
- Department of Plastic Surgery, Medstar Georgetown University Hospital, 3800 Reservoir Road Northwest, Washington, DC 20007, USA
| | - John S. Steinberg
- Department of Plastic Surgery, Georgetown University School of Medicine, 3800 Reservoir Road Northwest, Washington, DC 20007, USA
| | - Kelly Powers
- Department of Plastic Surgery, Medstar Georgetown University Hospital, 3800 Reservoir Road Northwest, Washington, DC 20007, USA
- Associated Podiatrists of Greenwich, 46 Milbank Avenue, Greenwich, CT 06830, USA
| | - Karen K. Evans
- Department of Plastic Surgery, Georgetown University School of Medicine, 3800 Reservoir Road Northwest, Washington, DC 20007, USA
| | - Paul J. Kim
- Department of Plastic Surgery, Georgetown University School of Medicine, 3800 Reservoir Road Northwest, Washington, DC 20007, USA
- *Paul J. Kim:
| | - Christopher E. Attinger
- Department of Plastic Surgery, Georgetown University School of Medicine, 3800 Reservoir Road Northwest, Washington, DC 20007, USA
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17
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Lesens O, Desbiez F, Theïs C, Ferry T, Bensalem M, Laurichesse H, Tauveron I, Beytout J, Aragón Sánchez J. Staphylococcus aureus–Related Diabetic Osteomyelitis. INT J LOW EXTR WOUND 2014; 14:284-90. [DOI: 10.1177/1534734614559931] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Staphylococcus aureus is the main cause of diabetic foot osteomyelitis (DFO) and can be treated medically or by surgery. We investigated the outcome of consecutive patients with a diagnosis of S aureus DFO retrospectively in 4 hospitals according to the type of management, medical (including debridement at bedside) or surgical. The outcome was classified as either favorable or failure (relapse, impaired wound healing, or amputation). Seventy-four patients with S aureus DFO, including 26 with methicillin-resistant S aureus, were included with a mean duration of follow-up of 21 ± 1 months. As part of the initial treatment, 47% underwent bone surgery followed with a short course of antibiotic. Others were treated with antibiotic therapy alone with bedside debridement. The outcome was favorable for 84% of these patients, with similar rates in the surgical and medical groups (80% vs 87%, P > .05). Patients in the medical group were less frequently hospitalized (49% vs 94%, P < .001) and had a shorter length of hospital stay (17 ± 3 vs 50 ± 12 days, P = .004). Patients in the surgery group received a shorter course of antibiotic therapy (10 ± 2 vs 11 ± 1 weeks, P = .001) with fewer side effects (9% vs 33%, P = .01). The type of management was not associated with subsequent new episode of noncontiguous DFO, which developed in 32% of cases. In conclusion, except significant differences in duration of hospitalization and antibiotic therapy, medical and surgical management of S aureus DFO had similar outcomes with a cure rate >80%.
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Affiliation(s)
- Olivier Lesens
- Service des maladies infectieuses et tropicales Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Françoise Desbiez
- Service d’endocrinologie Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Clément Theïs
- Service des maladies infectieuses et tropicales Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Tristant Ferry
- University of Lyon Claude Bernard, Lyon, France
- Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Henri Laurichesse
- Service des maladies infectieuses et tropicales Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | | | - Jean Beytout
- Service des maladies infectieuses et tropicales Hôpital Gabriel Montpied, Clermont-Ferrand, France
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Merlet A, Cazanave C, Dauchy FA, Dutronc H, Casoli V, Chauveaux D, De Barbeyrac B, Dupon M. Prognostic factors of calcaneal osteomyelitis. ACTA ACUST UNITED AC 2014; 46:555-60. [DOI: 10.3109/00365548.2014.914241] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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19
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Boffeli TJ, Collier RC. Near total calcanectomy with rotational flap closure of large decubitus heel ulcerations complicated by calcaneal osteomyelitis. J Foot Ankle Surg 2012; 52:107-12. [PMID: 22835723 DOI: 10.1053/j.jfas.2012.06.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Indexed: 02/03/2023]
Abstract
Osteomyelitis is a common late-stage sequela of deep heel ulceration and frequently results in leg amputation, because few options exist to effectively treat this challenging problem. A technique that has been successful at our institution is near total calcanectomy with rotational flap closure of large decubitus heel ulcers complicated by calcaneal osteomyelitis. A case series is presented of 3 patients with differing locations or "zones" of heel decubitus ulceration with acute osteomyelitis. A description of our preferred flap choice, given the zone of the ulceration, is demonstrated, as are the surgical principles for the treatment approach. This procedure is an effective option, provided specific principles are followed to achieve complete wound coverage and minimize pressure points both when in bed and when walking.
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Affiliation(s)
- Troy J Boffeli
- Foot and Ankle Surgical Residency, Regions Hospital/Health Partners Institute for Medical Education, Saint Paul, MN 55101, USA
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20
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Tiemann AH, Hofmann GO, Steen M, Schmidt R. Adult calcaneal osteitis: incidence, etiology, diagnostics and therapy. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2012; 1:Doc11. [PMID: 26504695 PMCID: PMC4582472 DOI: 10.3205/iprs000011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Calcaneal osteomyelitis presents a complicated situation. The specific anatomy of the os calcis and its surrounding soft tissues plays an important role in the planning and realization of the procedures needed in order to eradicate the osteomyelitic focus. The calcaneus represents a spongious bone; a fact that supports the developement of an osteomyelitis. It is the strongest bone of the foot and is highly important for the biomechanical features of physiological walking. The surrounding soft tissues are thin and contain various important anatomical structures. These might be damaged during the treatment of the osteomyelitis. In addition the vascularization of the os calcis is delicate and may be compromized during the surgical osteomyelitis treatment. Calcaneus osteomyelitis may be classified based on the routes of infection into exogenous and endogenous forms. Additionally from the clinical point of view acute and chronic forms may be distinguished from an early and a late infection. Exogenous calcaneal osteomyelitis mostly is the result of an infection with S. aureus. The treatment is equal to the therapy in other locations and based on: Eradication of the bone infectionSanitation of the soft tissue infectionReconstruction of bone and soft tissue Especially the preservation and restoration of the soft tissue is important. Thus plastic surgical procedures play an essential role. The main object of treatment is the preservation of a biomechanical functioning foot. This may be impossible due to the local situation. Calcanectomy or even below knee amputation may be needed in those cases.
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Affiliation(s)
- A. H. Tiemann
- Abteilung für Septische und Rekonstruktive Chirurgie, Klinik für Unfall- und Wiederherstellungschirurgie, BG-Kliniken Bergmannstrost Halle, Deutschland,*To whom correspondence should be addressed: A. H. Tiemann, Abteilung für Septische und Rekonstruktive Chirurgie, Klinik für Unfall- und Wiederherstellungschirurgie, BG-Kliniken Bergmannstrost Halle, Merseburgerstr. 165, 06112 Halle, Deutschland, Tel.: 0345-1326632, E-mail:
| | - G. O. Hofmann
- Abteilung für Septische und Rekonstruktive Chirurgie, Klinik für Unfall- und Wiederherstellungschirurgie, BG-Kliniken Bergmannstrost Halle, Deutschland,Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Friedrich-Schiller Universität Jena, Deutschland
| | - M. Steen
- Klinik für Plastische- und Handchirurgie, Brandverletztenzentrum, BG-Kliniken Bergmannstrost Halle, Deutschland
| | - R. Schmidt
- Klinik für Plastische- und Handchirurgie, Brandverletztenzentrum, BG-Kliniken Bergmannstrost Halle, Deutschland
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