Pressure ulcer-related pelvic osteomyelitis: evaluation of a two-stage surgical strategy (debridement, negative pressure therapy and flap coverage) with prolonged antimicrobial therapy

Andrianasolo, Johan; Ferry, Tristan; Boucher, F.; Château, J.; Shipkov, Hristo; Daoud, Fatiha; Braun, E.; Triffault-Fillit, Claire; Perpoint, Thomas; Laurent, François; Mojallal, A.; Chidiac, Christian; Valour, Florent

doi:10.1186/s12879-018-3076-y

Cited by 19 publications

(15 citation statements)

References 45 publications

(56 reference statements)

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“…Traditionally, surgeons believed that adequate infection control should be established before soft tissue coverage, [ 12 ] especially in fulminant infections. Therefore, attempts at infection control and confirmation of negative wound culture results led to delays in surgical management and discharge, which was inefficient and suboptimal.…”

Section: Introductionmentioning

confidence: 99%

Retrospective study of the efficacy of vascularized tissue transfer for treating antibiotic-resistant bacteria-infected wound

et al. 2021

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If wounds are infected with bacteria resistant to an empirical antibiotic regimen, effective wound treatment will be delayed. This can delay wound healing and lengthen hospital stays, increasing the costs to patients. Long-term antibiotic use can also result in minor and major complications, such as diarrhea, antibiotic resistance, or life-threatening leukopenia. Multidrug-resistant (MDR) bacteria make wound treatment even more difficult. Traditionally, surgeons thought that adequate infection control should be established before soft tissue coverage. However, wounds infected by MDR do not heal well with this traditional method and there are no optimal treatment guidelines for MDR bacteria-contaminated wounds. We reviewed 203 patients who underwent vascularized flap surgery from 2012 to 2019 to cover wounds. Class IV and I wounds were compared according to the Centers for Disease Control and Prevention classification. Class IV was further classified as antibiotic-resistant (ARB) and antibiotic-sensitive (ASB) bacteria. Wound size, mode, location, pathogens, healing time, and basic demographics were evaluated. Data were compared using Cramer's V and one-way ANOVA or independent t tests. The average healing time was longer in the ARB (19.7 [range 7–44] days) and ASB (17.9 [range 2–36] days) groups than in the Clean group (16.5 [range 7–28] days). Healing time differed in the 3 groups ( P = .036). It was longer in the class IV group than in the class I group ( P = .01). However, it was not statistically different between the ARB and ASB groups ( P = .164). In our study the difference in healing time was small when vascularized tissue transfer was done in ARB-infected wound compared with ASB-infected and clean wound. It is necessary to perform surgery using vascularized tissue for the infected wound of antibiotic-resistant bacteria.

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Section: Introductionmentioning

confidence: 99%

Retrospective study of the efficacy of vascularized tissue transfer for treating antibiotic-resistant bacteria-infected wound

et al. 2021

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“…Myocutaneous gluteus maximus flaps are more traumatic and may affect gluteus maximus function, depending on the amount of muscle sacrificed. The superior and inferior gluteal artery perforator flap requires knowledge of the perforator location and more complex planning and dissection [ 9 , 10 ]. For larger stage III and IV pressure ulcers, it would be ideal to have a reliable flap which is simple to design and elevate with minimal donor site morbidity.…”

Section: Introductionmentioning

confidence: 99%

The modified bilobed flap for reconstructing sacral decubitus ulcers

Jiao

Cui

et al. 2020

Burns &Amp; Trauma

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Background Sacral pressure ulcers are associated with high morbidity and, in some cases, result in mortality from severe sepsis. Local flaps are frequently used for reconstruction of stage III and IV pressure ulcers. An ideal flap should be simple to design, have a reliable vascular supply and minimal donor site morbidity. Our study evaluates the use of a bilobed flap based on the superficial branch of the superior gluteal artery or the posterior branch of the fourth lumbar artery to reconstruct the sacral pressure ulcer. Case presentation We performed a retrospective analysis of paraplegic patients with sacral pressure ulcers treated with our bilobed flaps from January 2015 to December 2019. A description of our management, operative protocol, outcome and complications is outlined. Seven paraplegic patients (6 male, 1 female; average age 53.1 years) with sacral pressure ulcers were treated with our bilobed flap based on the superficial branch of the superior gluteal artery or the posterior branch of the fourth lumbar artery. The average size of the pressure ulcers was 7 × 5 cm (range 6.2 × 4.5 cm to 11 × 10 cm). All 7 flaps survived. The patients were followed up for 12 months without significant complications, such as flap necrosis or recurrence. Conclusions The superficial branch of the superior gluteal artery or the posterior branch of the fourth lumbar artery reliably supplies the bilobed flap. The superior cluneal nerve can be included in the design. The technique is simple and reliable. It should be included in the reconstructive algorithm for the management of sacral pressure ulcers.

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“…Osteomyelitis can lead to other complications and also raise the cost of the treatments. 49 Several methods can be chosen to diagnose osteomyelitis, from bone biopsy as the gold standard to MRI which giving high sensitivity and specificity, or even with additional serum investigation (CRP, ESR, PCT). 50,51 Bone scan also can be used to eliminate osteomyelitis.…”

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confidence: 99%

“…The combination of these two is essential in shortening the duration of the management. 49 To prevent osteomyelitis, it is important to monitor the source of infection, pressure ulcer should be monitored carefully. If available, hyperbaric oxygen therapy can be used to treat chronic refractory osteomyelitis.…”

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confidence: 99%

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Infectious diseases as complications following spinal cord injury

Nolan

Mahadewa

2021

Neurologico Spinale Medico Chirurgico

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Background: Infectious complications in spinal cord injury (SCI) patients can increase the mortality and morbidity of the patients. The inability to do daily activity is the main cause of the occurrence of infectious complications. Good understanding and high awareness are needed to notice some infectious complications which are difficult to be diagnosed. Method: This paper is a literature review which was done by reviewing and searching journals with “infectious complication”, “spinal cord injury”, “infection” on the search engines. The authors found 52 articles are suitable to be composed as references for this paper. Outcome: Several infectious complications may occur following the incidence of SCI and have a lot of disadvantages. The causes of these infections are multifactorial. Urinary tract infection, infected pressure ulcer, pneumonia, and some other infectious diseases may appear as complications. Extra care in hygiene and sanitation is needed, besides, high awareness is needed to discover these complications. Conclusion: Monitoring post-SCI complications are complex and difficult. A high level of suspicion should be raised with frequent aseptic actions and procedures. Appropriate management including non-surgical or surgical procedures can be chosen to achieve the best outcomes. Early diagnosis and management are critical for the best treatment results.

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Pressure ulcer-related pelvic osteomyelitis: evaluation of a two-stage surgical strategy (debridement, negative pressure therapy and flap coverage) with prolonged antimicrobial therapy

Cited by 19 publications

References 45 publications

Retrospective study of the efficacy of vascularized tissue transfer for treating antibiotic-resistant bacteria-infected wound

Retrospective study of the efficacy of vascularized tissue transfer for treating antibiotic-resistant bacteria-infected wound

The modified bilobed flap for reconstructing sacral decubitus ulcers

Infectious diseases as complications following spinal cord injury

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