Bioactive glass as dead space management following debridement of type 3 chronic osteomyelitis

Abstract

Background Chronic osteomyelitis is a challenging condition to treat and although no exact treatment guidelines exist, the surgical management strategy includes wide resection of necrotic and infected bone followed by dead space management. This study evaluates the use of bioactive glass as a single-stage procedure for dead space management following surgical debridement. Methods A consecutive series of 24 patients with Cierny-Mader type 3 osteomyelitis, treated between March 2016 and June 2018, were identified and evaluated retrospectively. Patients were managed with bioactive glass as dead space management following surgical debridement. Results Of the patients who completed more than 12 months follow-up, all fourteen (100%) showed complete resolution of symptoms. Of the remaining ten patients with less than 12 months follow-up, eight had complete resolution of symptoms. Therefore, a preliminary result of 22 out of 24 patients (91.65%) had resolution of symptoms following debridement and dead space management with bioactive glass. One patient experienced a complication related to the use of bioactive glass. This manifested as prolonged serous wound drainage that resolved with local wound care. Conclusion The use of bioactive glass appears to be effective for dead space management following debridement of anatomical type 3 chronic osteomyelitis of the appendicular skeleton.

The management of chronic osteomyelitis in adults: outcomes of an integrated approach

“…Type II and type III osteomyelitis were managed by direct unroofing using a high-speed burr followed by dead space management and soft tissue reconstruction as required. Dead space management consisted of soft tissue reconstruction with or without Garacol ® gentamycin-loaded fleece insertion (Innocoll Pharmaceuticals, Ireland) in type II osteomyelitis and BonAlive ® 20 Most patients with diffuse osteomyelitis and skeletal instability (type IV) were managed by segmental resection of the necrotic bone followed by insertion of a physician-directed custom antibioticloaded cement spacer for dead space management. Palacos R+G cement (Heraeus Medical), containing 0.5 g of gentamycin per 40 g pack, was used to construct the cement spacers.…”

Bioactive glass S53P4 vs. autologous bone graft for filling defects in patients with chronic osteomyelitis and infected non-unions – a single center experience

“…Some studies have investigated the use of BAG in patients with chronic osteomyelitis. However, the number of cases in these studies was usually small, and most had no control group (Romano et al, 2014;Lindfors et al, 2017Lindfors et al, , 2010Auregan and Begue, 2015;McAndrew et al, 2013;Drago et al, 2013;Malat et al, 2018;Oosthuysen et al, 2020). Existing comparative studies compare BAG either with other bone substitutes (Table 4) or with PMMA beads (the gold standard for a two-stage procedure) and with the objective of investigating successful control of infection and dead space management of bone cavities, but not bone healing.…”

“…Autologous bone graft is the gold standard and has osteogenic, osteoinductive, and osteoconductive properties (Ferguson et al, 2017;Calori et al, 2011;De Long et al, 2007;Egol et al, 2015). However, the volume that can be achieved is limited, and donor site morbidity is considerable (Pape et al, 2010).…”

Current Concepts of Fracture-Related Infection

“…Recent studies confrmed the satisfying efcacy of local calcium sulfate with antibiotics in the treatment of bone infections, including among the pediatric patients [69,[84][85][86]. In addition to calcium sulfate, other types of antibiotic carriers have been reported, such as collagen sponge [87], porous alumina ceramic [88], and bioactive glass [89]. However, the number of such studies is still limited, which needs to be evaluated by more future studies.…”