Surgical treatment outcome after serial debridement of infected nonunion—A retrospective cohort study

Abstract

Purpose Reported outcome after multiple staged surgical treatment of infected nonunion is scarce. We, therefore, asked: (1) What is the clinical outcome in infected nonunion patients after multiple staged revision surgery? (2) Are different pathogens evidenced after surgical treatment in patients who have undergone more or less surgeries? Methods All enrolled patients were surgically treated for long bone-infected nonunion between January 2010 and March 2018. Besides patients´ demographics outcome in terms of bony consolidation and major complications defined as death during inward treatment, amputation and recurrence of infection during follow-up of at least 12 months were assessed. Microbiological findings were assessed and compared between two groups with less than five versus five or more surgical revisions. Results Bone consolidation was achieved in 86% of the patients while complications such as femoral or transtibial amputation, recurrence of infection or even death during inpatient treatment could be evidenced in six patients (14%). In patients who underwent multiple-stage surgery for five or more times, germ changes and repeated germ detection was more common than in patients with less surgeries. Conclusions Surgical treatment of infected nonunions poses a high burden on the patients with major complications occurring in about 14% of the patients using a multiple staged treatment concept. Future prospective studies comparing outcomes after limited with multiple staged revision surgeries are necessary.

The antibiotic bead pouch – a useful technique for temporary soft tissue coverage, infection prevention and therapy in trauma surgery

“…-The number of subsequent interventions can be reduced, thereby avoiding pathogen changes that often occur after multiple debridement stages (Rupp et al, 2022(Rupp et al, , 2020.…”

“…Changing the antibiotic beads every 48-72 h is not necessary when synthetic skin substitutes are used, and, with thorough debridement, the antibiotic bead pouch can be left in place until plastic reconstruction. The authors do not recommend staged revisions every 48-72 h, as this can result in pathogen changes, unnecessary consumption of surgical resources, and added stress for the patient (Rupp et al, 2022(Rupp et al, , 2020.…”