The efficacy of free tissue transfer in the treatment of osteomyelitis.

Weiland, Andrew J.; Moore, J. Russell; Daniel, Rollin K.

doi:10.2106/00004623-198466020-00004

Cited by 177 publications

(81 citation statements)

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“…7,8 To reduce the potential for infection further, soft-tissue cover was provided when the defect could not be closed primarily. Free-tissue transfers were used [35][36][37][38] in both this study and for the historical series. In studies on bacterial inoculation after free-tissue transfer, 35 it was found that a musculocutaneous flap can increase the resistance to bacterial infection.…”

Section: Discussionmentioning

confidence: 99%

“…It has been shown that while preoperative and postoperative smoking markedly increased the incidence of necrosis of flaps, 37 preoperative cessation of smoking decreased it. In an analysis of the efficacy of free-tissue transfer in the two-stage treatment of osteomyelitis 38 patients were treated with antibiotics for seven to ten days after radical debridement followed by an additional three to seven days at the time of free-tissue transfer. Thirty out of 37 (79%) grafts survived and there were five amputations.…”

Section: Discussionmentioning

confidence: 99%

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A comparison of short- and long-term intravenous antibiotic therapy in the postoperative management of adult osteomyelitis

Swiontkowski¹,

Hanel

Vedder

et al. 1999

The Journal of Bone and Joint Surgery. British volume

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T he current standard recommendation for antibiotic therapy in the management of chronic osteomyelitis is intravenous treatment for six weeks. We have compared this regime with short-term intravenous therapy followed by oral dosage.A total of 93 patients, with chronic osteomyelitis, underwent single-stage, aggressive surgical debridement and appropriate soft-tissue coverage. Culture-specific intravenous antibiotics were given for five to seven days, followed by oral therapy for six weeks. During surgery, the scar, including the sinus track, was excised en bloc. We used a high-speed, saline-cooled burr to remove necrotic bone, and osseous laser Doppler flowmetry to ensure that the remaining bone was viable. Infected nonunions (Cierny stage-IV osteomyelitis) were stabilised by internal fixation. In 38 patients management of dead space required antibiotic-impregnated polymethylmethacrylate beads, which were exchanged for an autogenous bone graft at six weeks. Free-tissue transfer often facilitated soft-tissue coverage. These 93 patients were compared with 22 consecutive patients treated previously who had the same surgical management, but received culture-specific intravenous antibiotics for six weeks.Of the 93 patients, 80 healed without further intervention. Of the 31 Cierny-IV lesions, 27 healed without another operation, and four fractures required additional bone grafts. No more wound drainage was needed. Treatment was successful in 91% of patients, regardless of the organism involved. There was no difference in outcome in terms of these variables when the series were compared. We conclude that the long-term administration of intravenous antibiotics is not necessary to achieve a high rate of clinical resolution of wound drainage for adult patients with chronic osteomyelitis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A comparison of short- and long-term intravenous antibiotic therapy in the postoperative management of adult osteomyelitis

Swiontkowski¹,

Hanel

Vedder

et al. 1999

The Journal of Bone and Joint Surgery. British volume

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show abstract

“…In addition, delayed coverage will give the surgical team more opportunities for a detailed and appropriate assessment of patientrelated variables (Edwards et al 1979). An important contributing factor for the poorer outcome after late management is that microsurgery is more difficult due to scar tissue and fibrosis that extend beyond the initial area of injury and involve the vessels (Weiland et al 1984, Yaremchuk 1989. Godina (1986) found the predominant cause of flap failures in delayed and late reconstructions to be anastomotic complications.…”

Section: Discussionmentioning

confidence: 99%

Team approach to tibial fracture

Hammer¹,

Lidman²,

Nettelblad³

et al. 1992

Acta Orthopaedica Scandinavica

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“…Vascularized bone flaps have been previously used to facilitate bone healing in cases of bone nonunions and large bony defects resulting either from trauma or from tumor excisions. 12,13,56,57,60 These flaps have been demonstrated to be effective in patients with a compromised ability to heal, such as patients receiving chemotherapy.…”

Section: 53mentioning

confidence: 99%

A new type of reconstruction of the hemipelvis after Type 3 amputative sacrectomy using pedicled fibula

Starantzis

Sakellariou

Rose

et al. 2014

SPI

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This is a technical note of pelvic reconstruction performed by an advanced multidisciplinary team. The authors report a new 3-stage reconstruction of the hemipelvis after Type 3 sacrectomy involving instrumented spinoiliac arthrodesis and pedicled fibula grafting in 2 patients. The anterior stage of the procedure begins with a transabdominal approach to mobilize the viscera and to free up the tumor from the vessels. The posterior divisions of internal iliac vessels, the middle sacral vessels, and the lateral sacral vessels are then ligated. An anterior vertebrectomy is done at the appropriate level, followed by an anterior osteotomy through the lateral planed surgical margin of the sacrum close to the salvaged sacroiliac joint. The second stage includes a major sacral resection with lower-extremity amputation from the pubic symphysis through the intact side of the sacrum, ipsilateral pedicled fibula harvesting, and closure with an ipsilateral pedicled quadriceps flap. The final stage involves reconstruction with lumboiliac instrumentation. The pedicled fibular graft left from the second stage is then placed distally within the previously created iliopectineal docking site and proximally within the L-5 docking site. The authors believe that this is a feasible and reproducible technique with theoretical advantages that have to be proved in the long-term follow-up.

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The efficacy of free tissue transfer in the treatment of osteomyelitis.

Cited by 177 publications

References 0 publications

A comparison of short- and long-term intravenous antibiotic therapy in the postoperative management of adult osteomyelitis

A comparison of short- and long-term intravenous antibiotic therapy in the postoperative management of adult osteomyelitis

Team approach to tibial fracture

A new type of reconstruction of the hemipelvis after Type 3 amputative sacrectomy using pedicled fibula

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