Muscle transposition for treatment and prevention of chronic post-traumatic osteomyelitis of the tibia

Ger, Ralph

doi:10.2106/00004623-197759060-00012

Cited by 118 publications

(41 citation statements)

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“…The AHM is used frequently as a proximallybased muscle flap in medial midfoot, heel, and ankle defects, and was introduced in the 1960s for the treatment of chronic ulcers or osteomyelitis of the foot and ankle region (Ger, 1977). It is also possible to use the AHM as a distally based flap by reversing the direction of blood flow (Schwabegger et al, 2003).…”

Section: Discussionmentioning

confidence: 99%

Correlation between the course of the medial plantar artery and the morphology of the abductor hallucis muscle

et al. 2005

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The abductor hallucis muscle flap is commonly used as a proximally-based flap in the management of ankle, heel, and midfoot lesions, where it is ideally suited for closing defects. This study investigates the anatomical details of this muscle in 13 fresh male cadavers. The medial plantar artery (MPA) was studied by dissection and macroscopic analyses to document the relationship of its superficial and deep branches with respect to the abductor hallucis muscle (AHM). Three main patterns could be described. In Pattern A (54%) the MPA divides into two branches. The deep branch reaches the deep surface of the AHM, supplying its proximal part, and the superficial branch courses between the AHM and the flexor digitorum brevis, to end as the first plantar metatarsal artery. The latter supplies two to three small branches to the distal part of the AHM. The fibers of the AHM end symmetrically on the two sides of the tendon and the muscle presents an arciform shape. The MPA, in Pattern B (38%), lacks a deep branch and continues along the lateral border of the AHM as a superficial branch that supplies proximal and distal collaterals to the muscle. The muscle fibers of the AHM end mainly on the medial side of the tendon. The muscle belly presents an arciform shape and is located on the medial margin of the foot superomedially with respect to Pattern A. In Pattern C (8%) the MPA continues as a large deep branch on the deep surface of the AHM and ends as the medial collateral artery of the big toe. A smaller superficial branch of the MPA provides a few collaterals to the AHM from its proximal part and to the flexor digitorum brevis in its distal part. The AHM fibers end mainly on the lateral side of the tendon and morphologically the muscle presents a straight line on the sole of the foot compared to Pattern A. Although Patterns B and C, from a surgical point of view, necessitate interruption of the main trunk of the MPA, Pattern A may permit the vascularization of the muscles of the medial side of the sole of the foot by the superficial trunk of the MPA. Because preoperative radiological study of the plantar vessels correlate with the morphological characteristics of the AHM observed during surgery, such imaging may be useful in determining the appropriate flap design based on the patient's unique pattern of MPA branching.

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Section: Discussionmentioning

confidence: 99%

Correlation between the course of the medial plantar artery and the morphology of the abductor hallucis muscle

et al. 2005

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“…Our plastic surgeons prefer the latissimus dorsi muscle for larger defects and the rectus abdominus and gracilis muscles for smaller reconstructions. The importance of soft-tissue coverage in treating osteitis and infected tibial pseudarthrosis has been reported in numerous articles [14,15,[26][27][28][29][30][31][32].…”

Section: Discussionmentioning

confidence: 99%

Infected Segmental Defect Pseudarthrosis of the Tibia

Hoogendoorn

Werken

2003

Eur J Trauma

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“…This has been demonstrated in situations where healing difficulties are well known. These include deep p r e s s u r e sores [Ger 1971], surgical implants [Ger 1976], chronic osteomyelitis [Ger 1977], and diabetic foot lesions [Ger 1983]. In the case of recalcitrant abdominal wall wounds, the use of transposed muscles offer an additional advantage, namely the prevention of a hernia by the placement of an actively c o n t r a c t i l e i n n e r v a t e d m u s c l e [Ger 1983].…”

Section: Discussionmentioning

confidence: 99%

The use of transposed rectus femoris muscle in the treatment of infected abdominal wounds

Ger

Angus

2000

Hernia

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Summary: A recent publication, where three experienced workers in the field of managing post-operative contaminated open wounds, especially of the abdominal wall, underscores the considerable number of different methods that are in vogue. Infected abdominal wounds are usually treated by debridement, the administration of appropriate antibiotics and wound closure on a delayed basis. In the presence of a surgical implant, the latter is often partially or completely removed depending on the circumstances that led to its insertion. While healing often results, there remain a hard core of recalcitrant cases where multiple operations are necessary to heal the wound. Over 30 years ago a method was introduced to treat a variety of non-healing and infected wounds, namely the use of transposed muscles. Experience shows that this approach is either unknown or rejected by physicians treating patients with recalcitrant wounds and, at times, major ablations are performed. Introduced originally by a general surgeon, the procedure is better known by those engaged in plastic surgery. At our wound center, patients who have been unsuccessfully treated by multiple operations are regularly seen, which indicates that physicians need to be reminded of this proven, but perhaps forgotten, method of management. For this reason an illustrative case report is presented of a patient whose abdominal wall hernia was treated and which resulted in an infected non-healing wound that was successfully managed using a transposed rectus femoris muscle.

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Muscle transposition for treatment and prevention of chronic post-traumatic osteomyelitis of the tibia

Cited by 118 publications

References 0 publications

Correlation between the course of the medial plantar artery and the morphology of the abductor hallucis muscle

Correlation between the course of the medial plantar artery and the morphology of the abductor hallucis muscle

Infected Segmental Defect Pseudarthrosis of the Tibia

The use of transposed rectus femoris muscle in the treatment of infected abdominal wounds

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