RSS-Feed abonnieren
PDF herunterladen
DOI: 10.1055/s-2003-39829
Treatment of Post-Traumatic Tibial Osteomyelitis Using Microsurgical Flaps
Publikationsverlauf
Publikationsdatum:
13. Juni 2003 (online)
ABSTRACT
Between 1994 and 1998, the authors treated 70 patients presenting with post-traumatic tibial osteomyelitis. Eighty-five percent were males, with a mean patient age of 32 years. The mean duration of the disease was 2 years. Fifty-one percent were of type IV in the Cierny-Mader classification. The mean follow-up period was 36 months. Case management was through thorough debridement, antibiotic therapy, and soft-tissue reconstruction using free flaps: latissimus dorsi (39.4 percent), scapular (28.2 percent), lateral arm (19.7 percent), and anterior serratus (12.7 percent). To evaluate the results, the control of infection and the quality of the soft tissue repaired were considered. The success rate was 90 percent. The authors conclude that their described method constitutes an effective treatment for post-traumatic tibial osteomyelitis.
KEYWORDS
Post-traumatic tibial osteomyelitis - microsurgical free flaps
REFERENCES
- 1 Perkins G. Surgical treatment of osteomyelitis due to a penetrating wound. British Med J . 1943; 1 441
- 2 Papineau L J. Excision-graft with deliberately delayed closing in chronic osteomyelitis. Nouv Presse Med . 1973; 2 2753
- 3 Ilizarov G A. Clinical application of the tension-stress effect for limb lengthening. Clin Orthop . 1990; 250 8
- 4 Ger R, Efron G. New operative approach in the treatment of chronic osteomyelitis of the tibial diaphysis: a preliminary report. Clin Orthop . 1970; 70 165
- 5 May J W, Gallico G G, Lukash F N. Microvascular transfer of free tissue for closure of bone wounds of the distal lower extremity. N Engl J Medicine . 1982; 306 253
- 6 Mathes S J, Alpert B S, Chang N. Use of the muscle flap in chronic osteomyelitis: experimental and clinical correlation. Plast Reconstr Surg . 1982; 69 815
- 7 Irons G B, Fisher J, Schmitt III E H. Vascularized muscular and musculocutaneous flaps for management of osteomyelitis. Orthop Clin North Am . 1984; 15 473
- 8 Weiland A J, Moore J R, Daniel R K. The efficacy of free tissue transfer in the treatment of osteomyelitis. J Bone Joint Surg . 1984; 66A 181
- 9 Holtom P, Smith A M. Introduction to adult post-traumatic osteomyelitis of the tibia. Clin Orthop . 1999; 360 6
- 10 Musharafieh R, Osmani O, Musharafieh U. et al . Efficacy of microsurgical free tissue transfer in chronic osteomyelitis of the leg and foot. J Reconstr Microsurg . 1999; 15 239
- 11 Cierny III G, Mader J T, Pennick J J. A clinical staging system for adult osteomyelitis. Contemp Orthop . 1985; 10 7
- 12 Marques S. Preenchimento das cavidades ósseas osteomielíticas com transplante muscular. Arq Brasil Cir Ortop . 1936; 4 223
- 13 Prigge E K. The treatment of chronic osteomyelitis by the use of muscle transplant or iliac graft. J Bone Joint Surg . 1946; 3B 576
- 14 Stark W J. The use of pedicled muscle flaps in the surgical treatment of chronic osteomyelitis resulting from compound fractures. J Bone Joint Surg . 1946; 28A 343
- 15 Chang N, Mathes S. A comparison of the effect of bacterial inoculation on musculocutaneous flap and random pattern flap. Plast Surg Forum . 1981; 4 18
- 16 May J W, Gallico G G. Comparative bacterial clearances of muscle and skin/subcutaneous tissue with and without dead bone: a laboratory study. Plast Reconstr Surg . 1990; 85 773
- 17 May J W, Lukash F N, Gallico G G. Latissimus dorsi free muscle flap in lower-extremity reconstruction. Plast Reconstr Surg . 1981; 68 603
- 18 Krizek T J, Robson M C. Evolution of quantitative bacteriology in wound management. Am J Surg . 1975; 130 579
- 19 Cooney W P, Fitzgerald R H, Dobyns J H, Washington II A J. Quantitative wound culture in upper extremity trauma. J Trauma . 1982; 22 112
- 20 Moore T J, Mauney C, Barron J. The use of quantitative bacterial counts in open fractures. Clin Orthop . 1989; 248 227
- 21 Gordon L, Chiu E J. Treatment of infected non-unions and segmental defects of the tibia with staged microvascular muscle transplantation and bone-grafting. J Bone Joint Surg . 1988; 70A 377
- 22 Cierny III G, Zorn K E. Segmental tibial defects: comparing conventional and Ilizarov methodologies. Clin Orthop . 1994; 301 118
- 23 Green A S. Skeletal defects: a comparison of bone grafting and bone transport for segmental skeletal defects. Clin Orthop . 1994; 301 111
- 24 Waldvogel F A, Medoff G, Swartz M N. Osteomyelitis: a review of clinical features, therapeutic considerations and unusual aspects. N Engl J Med . 1970; 282 198
- 25 Kelly P J, Fitzgerald Jr H R, Cabanela M E. Results of treatment of tibial and femoral osteomyelitis in adults. Clin Orthop . 1990; 259 295