Free Tissue Transfer with Distraction Osteogenesis Is Effective for Limb Salvage of the Infected Traumatized Lower Extremity

Chim, Harvey; Sontich, John K.; Kaufman, Bram R.

doi:10.1097/prs.0b013e318213a141

Cited by 37 publications

(29 citation statements)

References 14 publications

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“…8 Our results support the good outcomes achieved by combined orthopaedic and plastic surgery procedures for post-traumatic bone and soft-tissue defects. 24,25 Ziran et al 26 and Salvana et al 27 have reported good outcomes from using a multidisciplinary team approach to treat chronic osteomyelitis. Ziran et al 26 compared their outcomes before and after the introduction of a dedicated multidisciplinary team.…”

Section: Discussionmentioning

confidence: 99%

Management of infected nonunion of the long bones by a multidisciplinary team

Bose

Kugan²,

Stubbs

et al. 2015

The Bone & Joint Journal

122

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Infected nonunion of a long bone continues to present difficulties in management. In addition to treating the infection, it is necessary to establish bony stability, encourage fracture union and reconstruct the soft-tissue envelope. We present a series of 67 infected nonunions of a long bone in 66 patients treated in a multidisciplinary unit. The operative treatment of patients suitable for limb salvage was performed as a single procedure. Antibiotic regimes were determined by the results of microbiological culture. At a mean follow-up of 52 months (22 to 97), 59 patients (88%) had an infection-free united fracture in a functioning limb. Seven others required amputation (three as primary treatment, three after late failure of limb salvage and one for recalcitrant pain after union). The initial operation achieved union in 54 (84%) of the salvaged limbs at a mean of nine months (three to 26), with recurrence of infection in 9%. Further surgery in those limbs that remained ununited increased the union rate to 62 (97%) of the 64 limbs treated by limb salvage at final follow-up. The use of internal fixation was associated with a higher risk of recurrent infection than external fixation.

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Section: Discussionmentioning

confidence: 99%

Management of infected nonunion of the long bones by a multidisciplinary team

Bose

Kugan²,

Stubbs

et al. 2015

The Bone & Joint Journal

122

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“…2,3,32,33 However, it remains indisputable that the main disadvantage of the Ilizarov technique is the tedious process with external fixation that may take months to perform. Intense pin-track pain appeared in two patients.…”

Section: Discussionmentioning

confidence: 99%

Treatment of compound tibia fracture with microvascular latissimus dorsi flap and the Ilizarov technique: A cross-sectional study of long-term outcomes

Repo

Barner-Rasmussen

Roine

et al. 2016

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Summary Background: Extensive compound tibial fractures present reconstructive challenges. The present study aimed to assess the outcomes of microvascular latissimus dorsi (LD) flap combined with the Ilizarov technique for extensive compound tibial fractures with bone loss and bone healing complications. Methods: Patient records were reviewed retrospectively. The Lower Extremity Functional Scale (LEFS), the Disabilities of the Arm, Hand and Shoulder (DASH), and the 15D healthrelated quality of life (HRQoL) instrument were applied. Results: Between 1989 and 2014, 16 patients underwent reconstruction with a microvascular LD flap and bone transport (11/16) or late bone lengthening (5/16). The mean clinical follow-up time was 6.6 (standard deviation (SD): 6.5) years. Three patients had minor complications requiring reoperation. Partial necrosis of one flap required late flap reconstruction in one case. Late bone grafting was used to enhance union in eight of 16 cases. The mean new bone gain was 3.8 cm (SD: 2.5).Overall, 11 patients completed the questionnaires in a mean of 22.3 years (SD: 2.4) after surgery. The main findings revealed a relatively good function of the reconstructed limb and good shoulder function. The mean HRQoL was comparable to that of an age-standardized sample of the general population.

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“…Although Gosbell et al reported salvage of an ankle and foot with infected soft tissue and superficial malleolus using an experimental antifungal regimen of combination voriconazole and terbinafine therapy, bony involvement was limited in this patient 4. As reported recently by Chim et al, the use of distraction osteogenesis in combination with free tissue transfer has been used successfully for limb salvage of infected lower extremities following trauma 5…”

mentioning

confidence: 95%

A multi‐disciplinary approach to the management of fungal osteomyelitis: Current concepts in post‐traumatic lower extremity reconstruction: A case report

et al. 2011

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Limb salvage in fungal osteomyelitis of the post-traumatic lower extremity represents a difficult clinical problem requiring aggressive management. We report lower extremity salvage by radical bony debridement, free tissue transfer, distraction osteogenesis with bone-docking, and a novel antifungal regimen in a clinical setting of infection with Scedosporium inflatum, historically requiring amputation in 100% of cases. We treated Scedosporium inflatum osteomyelitis of the tibia and calcaneus with radical debridement of infected bone, free partial medial rectus abdominis muscle flap coverage, transport distraction osteogenesis, and combination voriconazole/terbinafine chemotherapy, a novel antifungal regimen. We achieved successful control of the infection, limb salvage, and an excellent functional outcome through aggressive debridement of infected bone and soft tissue, elimination of dead space within the bony defect, the robust perfusion provided by the free flap, the hypervascular state induced by distraction osteogenesis, and the synergism of the novel antifungal regimen.

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Free Tissue Transfer with Distraction Osteogenesis Is Effective for Limb Salvage of the Infected Traumatized Lower Extremity

Cited by 37 publications

References 14 publications

Management of infected nonunion of the long bones by a multidisciplinary team

Management of infected nonunion of the long bones by a multidisciplinary team

Treatment of compound tibia fracture with microvascular latissimus dorsi flap and the Ilizarov technique: A cross-sectional study of long-term outcomes

A multi‐disciplinary approach to the management of fungal osteomyelitis: Current concepts in post‐traumatic lower extremity reconstruction: A case report

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