1
|
Cong B, Chen M. Evaluating the efficacy of combined flap coverage, antibiotic-loaded bone cement and negative pressure irrigation in traumatic osteomyelitis management. Int Wound J 2024; 21:e14650. [PMID: 38272791 PMCID: PMC10794078 DOI: 10.1111/iwj.14650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
Traumatic osteomyelitis with accompanying soft tissue defects presents a significant therapeutic challenge. This prospective, randomised controlled trial aims to evaluate the efficacy of antibiotic-impregnated bone cement, flap coverage and negative pressure sealed irrigation in the management of traumatic osteomyelitis complicated by soft tissue defects. A total of 46 patients with clinically diagnosed traumatic osteomyelitis and soft tissue defects were randomised into a control group (n = 23) and an observation group (n = 23). The control group underwent standard flap coverage and negative-pressure lavage, while the observation group received an additional treatment with antibiotic-loaded bone cement. Efficacy was measured based on clinical criteria, surgical metrics and morphometric assessment of bone and soft tissue defects. Statistical analyses were performed using SPSS version 27.0. The observation group, treated with an integrated approach of flap coverage, negative pressure wound therapy (NPWT) and antibiotic-impregnated bone cement, demonstrated significantly higher overall treatment efficacy (91.3%) compared to the control group, which received only flap coverage and NPWT (65.2%) (p < 0.01). This enhanced efficacy was evidenced through various outcomes: the observation group experienced reduced surgical times, shorter hospital stays, fewer dressing changes and accelerated wound healing, all statistically significant (p < 0.001). Additionally, a quantitative analysis at 6-month post-treatment revealed that the observation group showed more substantial reductions in both bone and soft tissue defect sizes compared to the control group (p < 0.001). The multi-modal treatment strategy, combining skin flap coverage, antibiotic bone cement and negative-pressure irrigation, showed marked efficacy in treating traumatic osteomyelitis and associated soft tissue defects. This approach accelerated postoperative recovery and lowered costs.
Collapse
Affiliation(s)
- Bo Cong
- Department of OrthopedicsYantaishan Hospital Affiliated to Binzhou Medical UniversityYantaiChina
- Yantai Key Laboratory for Repair and Reconstruction of Bone & JointYantaishan Hospital Affiliated to Binzhou Medical UniversityYantaiChina
| | - Mingqi Chen
- Department of OrthopedicsYantaishan Hospital Affiliated to Binzhou Medical UniversityYantaiChina
- Yantai Key Laboratory for Repair and Reconstruction of Bone & JointYantaishan Hospital Affiliated to Binzhou Medical UniversityYantaiChina
| |
Collapse
|
2
|
Maruccia M, Tedeschi P, Caizzi G, Palmiotto F, Di Summa PG, Vicenti G, Moretti B, Giudice G, Elia R. Graft and Flap: Orthoplastic Approach to Achilles Tendon Secondary Rupture. Plast Reconstr Surg 2023; 152:1359-1364. [PMID: 37092978 DOI: 10.1097/prs.0000000000010566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
SUMMARY Achilles tendon rupture represents one of the most common tendon ruptures. Although primary repair remains the treatment of choice, surgical complications, such as secondary rupture and tendon exposure, require salvage procedures. This article aims to present the authors' orthoplastic approach for the functional reconstruction of composite secondary Achilles tendon defects. Seven patients with chronic open-wound and large Achilles tendon defects (Kuwada type IV) underwent one-stage reconstruction between October of 2018 and October of 2020. The size of the average soft-tissue defect was 126.2 cm 2 (range, 86.1 to 175.9 cm 2 ), with a tendon gap of 8.2 cm (range, 7.1 to 10.3 cm). A combined team of orthoplastic surgeons performed the reconstructive procedure, using a turndown gastrocnemius fascial flap and a fascia lata autograft for the tendon reconstruction and a free fasciocutaneous anterolateral thigh flap for soft-tissue coverage (graft and flap). Subjective evaluation and quality-of-life measures were obtained preoperatively and 12 months postoperatively using the American Orthopedic Foot and Ankle Score and 36-Item Short-Form Health Survey questionnaire. Mean follow-up was 18.3 months (range, 12 to 24 months). The flap survival rate was 100%. Overall range of motion of the reconstructed side was 87% of the unaffected side (54 degrees versus 62 degrees). The American Orthopedic Foot and Ankle Score and 36-Item Short-Form Health Survey scores of all patients improved significantly ( P < 0.005) at 12 months of follow-up. A microsurgical approach combined with orthopedic techniques can solve complex cases of Achilles tendon secondary rupture, providing a reconstructed tendon that achieves satisfactory anatomic shape and function. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
Collapse
Affiliation(s)
- Michele Maruccia
- From the Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari
| | - Pasquale Tedeschi
- From the Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari
| | - Gianni Caizzi
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro"
| | - Florianna Palmiotto
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro"
| | - Pietro G Di Summa
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Centre Hospitalier Universitaire Vaudois, University of Lausanne
| | - Giovanni Vicenti
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro"
| | - Biagio Moretti
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro"
| | - Giuseppe Giudice
- From the Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari
| | - Rossella Elia
- From the Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari
| |
Collapse
|
3
|
The Free Tissue Transfer-Masquelet-Reamer-Irrigator-Aspirator Bone Graft Orthoplastic Approach for Lower Extremity Reconstruction. Plast Reconstr Surg 2022; 149:1203e-1208e. [PMID: 35426862 DOI: 10.1097/prs.0000000000009133] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
SUMMARY The management of critical-sized bone and soft-tissue defects of the lower extremity poses unique challenge to reconstructive surgeons. The aim of this article is to present the authors' current orthoplastic approach for the management of extended (more than 6 cm) osteocutaneous defects of the lower extremity, based on a sequential combination of two stages: free flap for soft-tissue coverage and the Masquelet technique (first step) followed by reamer-irrigator-aspirator cancellous bone graft and definitive osteosynthesis (second step). This study was a single-center observational retrospective review of prospectively collected data. Adult patients (>18 years of age) with segmental bone loss of the lower extremity caused by acute trauma (Gustilo type IIIB fracture) or nonunion (septic/aseptic) who were treated with the free flap for soft-tissue coverage-Masquelet technique-reamer-irrigator-aspirator approach between January of 2017 and December of 2020 were included. Time of consolidation and early and late complications were recorded. A total of 11 patients (nine male patients and two female patients) with a mean age of 45.8 years were identified. The average bone gap length (standard deviation) was 87.3 (24.9) mm. An anterolateral thigh flap was harvested in all cases. The average duration of the first stage (i.e., time from antibiotic cement spacer placement and free flap to time of bone grafting) was 50.4 days (range, 40 to 62 days). Bone consolidation was achieved in all cases after an average period (standard deviation) of 20.4 (3.3) weeks, with acceptable functional outcomes. The free flap for soft-tissue coverage-Masquelet technique-reamer-irrigator-aspirator approach could be considered a viable option in patients with segmental critical-sized bone defects associated with a large soft-tissue deficit of the lower extremity. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
Collapse
|
4
|
Limb Elevation by Transcalcaneal Steinmann Pin in Lower Extremity Free Flap Reconstruction. Plast Reconstr Surg 2022; 149:1052e-1054e. [PMID: 35312662 DOI: 10.1097/prs.0000000000009003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
5
|
VICENTI G, OTTAVIANI G, BIZZOCA D, CARROZZO M, SIMONE F, GROSSO A, ZAVATTINI G, ELIA R, MARUCCIA M, SOLARINO G, MORETTI B. The role of biophysical stimulation with pemfs in fracture healing: from bench to bedside. MINERVA ORTHOPEDICS 2022. [DOI: 10.23736/s2784-8469.21.04116-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
6
|
He J, Guliyeva G, Wu P, Yu F, Qing L, Tang J. Reconstruction of Complex Soft Tissue Defects of the Heel With Versatile Double Skin Paddle Anterolateral Thigh Perforator Flaps: An Innovative Way to Restore Heel Shape. Front Surg 2022; 9:836505. [PMID: 35237651 PMCID: PMC8884269 DOI: 10.3389/fsurg.2022.836505] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Complex heel defects constitute a significant challenge for plastic surgeons. Objectives In this study, versatilities of free double skin paddle ALT flaps in the reconstruction of complex soft tissue defects of heels were explored. Methods From January 2010 to December 2019, 16 patients (13 male and 3 females) aged 16–74 years underwent double skin paddle ALT flap reconstruction in our department. All the patients had large defects located at the heel, and 5 had a dead space. Underlying structures such as vessels, bones, and tendons were exposed in all cases. Results Flap survival rate was 100% after the reconstruction. Eleven double skin paddle ALT flaps and 5 vastus lateralis muscle-chimeric double skin paddle ALT flaps were used. The size of the skin flap ranged from 9.5 × 4.5 cm2 to 22 × 10 cm2, and the size of a muscle segment ranged from 6 × 3 × 1 cm3 to 10 × 3 × 2 cm3. The mean follow-up was 22.6 months (range: 10–81 months). The wounds healed well, providing reliable soft tissue coverage and good heel contour. All the patients ambulated independently during the follow-up period. Most of them regained protective sensation. The average two-point discrimination was 32.7 mm (range: 27–37 mm). Conclusion Double skin paddle ALT flaps are a feasible option for the reconstruction of complex heel defects, with good functional and aesthetic results. Nonetheless, further studies comparing double skin paddle ALT flaps to other flap techniques are needed.
Collapse
Affiliation(s)
- Jiqiang He
- Xiangya Hospital, Central South University, Changsha, China
| | - Gunel Guliyeva
- The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Panfeng Wu
- Xiangya Hospital, Central South University, Changsha, China
| | - Fang Yu
- Xiangya Hospital, Central South University, Changsha, China
| | - Liming Qing
- Xiangya Hospital, Central South University, Changsha, China
| | - Juyu Tang
- Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Juyu Tang
| |
Collapse
|
7
|
Vasconcelos BM, Matiotti Neto M, Rezende LGRA, Cagnolati AF, Irusta AEC, Mazzer N. Fixador externo tipo delta no manejo pós-operatório de retalhos microcirúrgicos no membro inferior: Experiência de um hospital terciário. Rev Bras Ortop 2021; 57:69-74. [PMID: 35198111 PMCID: PMC8856863 DOI: 10.1055/s-0041-1735832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/07/2021] [Indexed: 11/30/2022] Open
Abstract
Objective
To evaluate the use of external fixators in the delta-type kickstand configuration as an adjuvant method in the postoperative period of patients submitted to free flaps in the lower limbs.
Methods
A total of 17 external delta fixators were used in patients submitted to free flaps in the lower limbs. The surgical technique was performed in a standardized manner, with the distal pin located 6 cm proximally to the anastomosis, and the proximal pin, 6 cm distally to the anterior tuberosity of the tibia.
Results
The mean age of the sample was of 34.76 years (range: 15 to 66 years). In total, 11 men and 6 women were selected. The posterior tibial artery was used in 14 cases, and the anterior tibial artery, in 3 cases. The mean time of use of the external fixators was of 3.88 weeks. The rate of reoperation was of 17.64%; that of retail loss was of 11.76%; that of success rate was of 88.23%; and the rate of infection was of 5.9%.
Conclusion
The use of delta-type fixators as an adjunct method in the postoperative period is reliable; however, more studies are needed to evaluate its true role in the postoperative period.
Collapse
Affiliation(s)
- Bruno Moraes Vasconcelos
- Programa de Cirurgia da Mão do Departamento de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HC-FMRP-USP), Ribeirão Preto, SP, Brasil
| | - Mario Matiotti Neto
- Programa de Cirurgia da Mão do Departamento de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HC-FMRP-USP), Ribeirão Preto, SP, Brasil
| | - Luis Guilherme Rosifini Alves Rezende
- Divisão de Cirurgia da Mão do Departamento de Ortopedia, Traumatologia e Anestesiologia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HC-FMRP-USP), Ribeirão Preto, SP, Brasil
| | - Amanda Favaro Cagnolati
- Divisão de Cirurgia da Mão do Departamento de Ortopedia, Traumatologia e Anestesiologia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HC-FMRP-USP), Ribeirão Preto, SP, Brasil
| | - Alex Eduardo Calderón Irusta
- Divisão de Cirurgia da Mão do Departamento de Ortopedia, Traumatologia e Anestesiologia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HC-FMRP-USP), Ribeirão Preto, SP, Brasil
| | - Nilton Mazzer
- Professor Titular e Chefe da Divisão de Cirurgia da Mão do Departamento de Ortopedia, Traumatologia e Anestesiologia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HC-FMRP-USP), Ribeirão Preto, SP, Brasil
| |
Collapse
|
8
|
Abstract
OBJECTIVE Management of complex foot injuries including skin, tendons, vessels, bone, with soft tissue defects is considered as an orthopedic challenge. Microsurgical free muscle flaps provide the best solution in such cases. PATIENTS AND METHODS Thirty two consecutive cases of complex ankle and foot injuries were treated by skin grafted muscle free flap in one stage procedure after radical debridement. Twenty four were males and 8 were females. Right foot was affected in 26 and left was involved in 6 patients. The average age was 22 years (range 6-33 years). The most common cause of injury was motor car accident. All cases had complex soft tissue defect with bone exposure. All cases were candidate for amputation. Gracilis muscle transfer was done in 26 cases and latissimus dorsi free flap in 6 cases. The average follow up was 38 months. RESULTS All the free muscle flaps survived. The involved bone fracture was united at an average 3 months. No evidence of osteomyelitis was noted. Full weight bearing was restored 3 months post-operatively. All patients were satisfied with the cosmetic appearance and functional capacity of their operated limbs. CONCLUSION Skin-grafted free muscle flap as one-stage procedure is a good solution for reconstruction of complex ankle and foot injuries.
Collapse
|
9
|
Moucharafieh RC, Nehme AH, Badra MI, Rahal MJH. Rectus abdominis free tissue transfer in lower extremity reconstruction: Long term follow up in 58 cases. Injury 2019; 50 Suppl 5:S25-S28. [PMID: 31699350 DOI: 10.1016/j.injury.2019.10.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
UNLABELLED This study evaluates the long-term results of rectus abdominis free-tissue transfer performed for lower extremity reconstruction. METHODS Over a period of 8 years 58 were available for long term follow-up. Indications for reconstruction included acute wounds with soft tissue defects, diabetic foot ulcers, and chronic osteomyelitis. RESULTS At a mean follow-up of 18 years, there were no major complications in the soft tissue defect coverage group except for one patient who continued to have recurrent folliculitis over the weight bearing heel area, which was treated by repeated debridement. Among the diabetic patients, two patients had recurrent ulcerations of the forefoot which were detected early and treated conservatively. In the osteomyelitis group, however, there were no recurrences of the foot infection. CONCLUSIONS The rectus abdominis free-tissue transfer provided an excellent method of soft tissue reconstruction with a very minimal long-term complication rate, and a very high rate of success in the treatment of diabetic foot ulcers and chronic osteomyelitis.
Collapse
Affiliation(s)
- Ramzi C Moucharafieh
- Department of Orthopedic Surgery and Traumatology, Saint Georges University Medical Center, Balamand University, P.O. Box 166378, Achrafieh, Beirut 1100 2807, Lebanon; Department of Orthopedic Surgery and Traumatology, Clemenceau Medical Center affiliated with Johns Hopkins International, Clemenceau Beirut, Lebanon.
| | - Alexandre H Nehme
- Department of Orthopedic Surgery and Traumatology, Saint Georges University Medical Center, Balamand University, P.O. Box 166378, Achrafieh, Beirut 1100 2807, Lebanon
| | - Mohammad I Badra
- Department of Orthopedic Surgery and Traumatology, Clemenceau Medical Center affiliated with Johns Hopkins International, Clemenceau Beirut, Lebanon
| | - Mohammad Jawad H Rahal
- Department of Orthopedic Surgery and Traumatology, Clemenceau Medical Center affiliated with Johns Hopkins International, Clemenceau Beirut, Lebanon
| |
Collapse
|
10
|
Elia R, Di Taranto G, Amorosi V, Ngamcherd S, Alamouti R, Liao LY, Maruccia M, Giudice G, Chen HC. The versatility of the thoracodorsal artery based composite flaps with vascularized rib and a systematic review of the literature. J Surg Oncol 2019; 120:527-539. [PMID: 31197840 DOI: 10.1002/jso.25579] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 04/01/2019] [Accepted: 05/18/2019] [Indexed: 11/05/2022]
Abstract
Pedicled and free composite flaps derived from the thoracodorsal artery system, including the latissimus dorsi-rib (LD-R) and the serratus anterior-rib (SA-R) osteo-muscular or osteo-myocutaneous flaps, are potential options to address head and neck, thorax, upper and lower extremity bone, and soft tissue defects' reconstruction. We aimed to report our series of LD/SA-R composite pedicled and free flaps, evaluating outcomes and complications, and to systematically identify all literature reporting results following LD/SA-rib reconstructions.
Collapse
Affiliation(s)
- Rossella Elia
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Giuseppe Di Taranto
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Plastic and Reconstructive Surgery, Sapienza University of Rome, Umberto I University Hospital, Rome, Italy
| | - Vittoria Amorosi
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Plastic Surgery Unit, Sant'Andrea Hospital, School of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Sitpahul Ngamcherd
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Plastic and Maxillofacial Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Reza Alamouti
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Plastic and Reconstructive Surgery, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Li-Ying Liao
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Michele Maruccia
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Giuseppe Giudice
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| |
Collapse
|