Preoperative Embolization of Heterotopic Ossification for the Treatment of a Recalcitrant Pressure Sore

Appelt, E.; Kenkel, Jeffrey M.; Ballard, Joan R.; Lopez, Jorge A.; Anthony, Thomas; Castillo, Teodoro

doi:10.1097/01.prs.0000178793.53400.d4

Cited by 5 publications

(3 citation statements)

References 14 publications

(18 reference statements)

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“…HO has traditionally been a challenging diagnosis to successfully treat. Surgical excision has been described as the treatment of choice for symptomatic HO (1,2). As with all invasive surgical procedures, there is a risk of infection and blood loss (1), a considerable rehabilitation process and accumulation of scar tissue.…”

Section: Discussionmentioning

confidence: 99%

Management of Pelvic Heterotopic Ossification Post-Myocutaneous Flap Reconstruction of a Sacral Pressure Ulcer

McInnes

Reynolds

Arneja

2011

Canadian Journal of Plastic Surgery

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Heterotopic ossification (HO) is a process whereby lamellar bone forms in the soft tissues surrounding a joint. The most common type of HO is traumatic myositis ossificans, which develops following traumatic injuries, burns or arthroplasty. A variety of other forms of HO also exist, such as those associated with central nervous system injury and systemic forms that can manifest at other joints simultaneously. Clinically, patients can present with decreased range of motion, pressure ulcers, nerve compression, swelling, pain or asymptomatically. Symptomatic patients are most commonly treated with surgical debridement of the affected heterotopic deposits. Spinal dysraphism (SD) is a term describing a wide range of congenital malformations of the neural tube, ranging from spina bifida occulta to the more severe form, myelomeningocele. The cause of SD is multifactorial and has been associated with chromosomal disorders, teratogenic exposure and folate deficiency. Many patients with SD experience neuropathy below the affected neurological level, making them particularly susceptible to pressure ulcers. If these ulcers are severe and do not respond to conservative therapy, they often require surgical debridement and flap reconstruction – a clinical scenario that rarely results in HO. The present article describes a case involving a patient with pelvic HO following myocutaneous flap reconstruction of a pressure ulcer. The patient was successfully treated with oral bisphosphonate and aggressive physiotherapy.

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Section: Discussionmentioning

confidence: 99%

Management of Pelvic Heterotopic Ossification Post-Myocutaneous Flap Reconstruction of a Sacral Pressure Ulcer

McInnes

Reynolds

Arneja

2011

Canadian Journal of Plastic Surgery

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“…Surgical excision has been described as the treatment of choice for symptomatic HO (1,2). As with all invasive surgical procedures, there is a risk of infection and blood loss (1), a considerable rehabilitation process and accumulation of scar tissue.…”

Section: Discussionmentioning

confidence: 99%

Management of pelvic heterotopic ossification post-myocutaneous flap reconstruction of a sacral pressure ulcer

2011

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A 16-year-old Caucasian boy with a diagnosis of spinal dysraphism at the L5 level presented with a two-month history of a recurrent right ischial pressure ulcer. His surgical history included debridement and flap reconstruction of previous sacral and right ischial ulcers. On physical examination, a stage IV pressure ulcer was present overlying the right ischium in the setting of local postsurgical scarring. Computed tomography confirmed right ischial osteomyelitis. The patient was treated with wide surgical debridement of the involved soft tissues, ostectomy of the right ischial tuberosity and right gluteus maximus myocutaneous flap reconstruction, with postoperative care in the prone and lateral positions. Three months postoperatively, the patient complained of limited hip mobility; a plain pelvis radiograph confirmed bilateral heterotopic ossification (HO) of the iliac crests to the femurs (Figure 1). The patient was subsequently treated with a six-month course of aggressive physical therapy (twice a day treatment sessions) and oral bisphosphonate (etidronate 20 mg/kg three times a day), which resulted in significant clinical and radiographic improvement of bilateral hip range of motion (Figure 2). DisCUssionHO has traditionally been a challenging diagnosis to successfully treat. Surgical excision has been described as the treatment of choice for symptomatic HO (1,2). As with all invasive surgical procedures, there is a risk of infection and blood loss (1), a considerable rehabilitation process and accumulation of scar tissue. Furthermore, due to the high recurrence rates, if surgical resection is performed on an immature lesion, treatment is often delayed for months before operative intervention is performed on mature lesions (3).Another option is radiation treatment, which can be used for both therapeutic and prophylactic purposes in HO (4-6). The therapeutic use of radiation therapy in established HO was first described by Schaeffer and Sosner (5) in 1995, who found that giving a 2 gray dose of radiation for several consecutive days resulted in improved range of motion. For prophylactic therapy, a single dose of 700 centigray administered within 48 h postoperatively is effective at reducing the recurrence rate of HO (7). Side effects of radiation therapy are common and present an obvious limitation to this treatment modality. An alternative postoperative prophylactic option is a course of a nonsteroidal anti-inflammatory Heterotopic ossification (HO) is a process whereby lamellar bone forms in the soft tissues surrounding a joint. The most common type of HO is traumatic myositis ossificans, which develops following traumatic injuries, burns or arthroplasty. A variety of other forms of HO also exist, such as those associated with central nervous system injury and systemic forms that can manifest at other joints simultaneously. Clinically, patients can present with decreased range of motion, pressure ulcers, nerve compression, swelling, pain or asymptomatically. Symptomatic patients are most commonly treated ...

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“…Mass effect from HO development in the thoracic cavity results in thoracic insufficiency syndrome, ultimately leading to hypoxemia, pneumonia, and heart failure [ 8 , 11 ]. In addition, masses near the surface of the body can increase the risk of skin breakdown and pressure sores [ 12 , 13 ].…”

Section: Clinical Picture Of Tho and Fopmentioning

confidence: 99%

Intersections of Fibrodysplasia Ossificans Progressiva and Traumatic Heterotopic Ossification

Juan,

Bancroft,

Choi

et al. 2024

Biomolecules

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Heterotopic ossification (HO) is a debilitating pathology where ectopic bone develops in areas of soft tissue. HO can develop as a consequence of traumatic insult or as a result of dysregulated osteogenic signaling, as in the case of the orphan disease fibrodysplasia ossificans progressiva (FOP). Traumatic HO (tHO) formation is mediated by the complex interplay of signaling between progenitor, inflammatory, and nerve cells, among others, making it a challenging process to understand. Research into the pathogenesis of genetically mediated HO (gHO) in FOP has established a pathway involving uninhibited activin-like kinase 2 receptor (ALK2) signaling that leads to downstream osteogenesis. Current methods of diagnosis and treatment lag behind pre-mature HO detection and progressive HO accumulation, resulting in irreversible decreases in range of motion and chronic pain for patients. As such, it is necessary to draw on advancements made in the study of tHO and gHO to better diagnose, comprehend, prevent, and treat both.

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Preoperative Embolization of Heterotopic Ossification for the Treatment of a Recalcitrant Pressure Sore

Cited by 5 publications

References 14 publications

Management of Pelvic Heterotopic Ossification Post-Myocutaneous Flap Reconstruction of a Sacral Pressure Ulcer

Management of Pelvic Heterotopic Ossification Post-Myocutaneous Flap Reconstruction of a Sacral Pressure Ulcer

Management of pelvic heterotopic ossification post-myocutaneous flap reconstruction of a sacral pressure ulcer

Intersections of Fibrodysplasia Ossificans Progressiva and Traumatic Heterotopic Ossification

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