Surgical treatment of osteomyelitis.

REOrthopaedics, Inc., San Diego, CA, USA.
Plastic and reconstructive surgery (Impact Factor: 2.74). 01/2011; 127 Suppl 1:190S-204S. DOI: 10.1097/PRS.0b013e3182025070
Source: PubMed

ABSTRACT Chronic osteomyelitis is refractory to nonsurgical treatment due to a resilient, infective nidus that harbors sessile, matrix-protected pathogens bound to substrate surfaces within the wound. Curative treatment mandates physical (surgical) removal of the biofilm colony, adjunctive use of antibiotics to eliminate residual phenotypes, and efforts to optimize the host response throughout therapy. Patient selection, therapeutic options, and the treatment format are determined by the Cierny/Mader staging system, while reconstruction is governed by the integrity/stability of the affected bone(s) and quality/quantity parameters of the soft-tissue envelope.

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    ABSTRACT: Calcaneal osteomyelitis is one of the most devastating complications encountered with the surgical treatment of calcaneal fractures. Previous treatments have focused on infection ablation, followed by either bracing or amputation. Few reports have focused on a staged procedure and ultimate functional reconstruction of the calcaneus. The case presented utilized a flexor hallucis longus tendon transfer with reattachment of the Achilles tendon, and implantation of a femoral head allograft. At 24 month follow-up, the patient was able to return to all pre-injury activities, without bracing or assistance.
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    South African Orthopaedic Journal. 05/2014; 13(2):42.
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    ABSTRACT: Over the past few decades considerable progress has been made in terms of our ability to reconstruct postinfective soft tissue and bone defects. Soft tissue reconstruction is not always required and it is frequently possible to achieve a tension-free closure of well-perfused tissue following debridement. It is now generally accepted that primary closure of the wound, be it by direct suturing or tissue transfer, may be performed at the same sitting as the debridement. In cases were debridement has resulted in tissue loss, muscle or musculocutaneous flaps appear to be superior to random-pattern flaps in achieving resolution of infection. The management of bone defects is dependent on several factors including the host’s physiological status, the size of the defect, duration of the defect, quality of the surrounding soft tissue, the presence of deformity, joint contracture/instability or limb length discrepancy, as well as the experience of the surgeon. Surgery remains the mainstay of treatment when a curative treatment strategy is selected. As is the case with chemotherapy for bone tumours, antibiotic therapy fulfils an adjuvant role in curative management strategies. The choice of antibiotic, in this setting, remains a very difficult one and there are many problems with the interpretation of ‘cure rate’ data. The controversy surrounding the optimal duration and route of antibiotic therapy has not been resolved. The second role of antibiotics in the management of chronic osteomyelitis is disease suppression as part of a palliative treatment strategy. Further studies are required to clarify which patients may successfully be treated with antibiotics alone.
    SA Orthopaedic Journal. 10/2014; 13(3):32-39.


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