Journal of Bone and Joint Infection最新文献

{"title":"Coagulation disorders during treatment with cefazolin and rifampicin: rare but dangerous.","authors":"Ines Kouki,&nbsp;Clémence Montagner,&nbsp;Wladimir Mauhin,&nbsp;Jonathan London,&nbsp;Thierry Lazard,&nbsp;Sylvie Grimbert,&nbsp;Valérie Zeller,&nbsp;Olivier Lidove","doi":"10.5194/jbji-6-131-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-131-2021","url":null,"abstract":"<p><p>We describe a 79-year-old man with spondylodiscitis and unknown pathogen, treated with cefazolin and rifampicin. He developed a massive digestive hemorrhage. Prothrombin time was prolonged with severe vitamin-K-dependent clotting-factor deficiency. Severe bleeding can occur during cefazolin and rifampicin use. This deficiency should be assessed before prescribing cefazolin-rifampicin and prothrombin time monitored.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"6 5","pages":"131-134"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8131959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39075887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Pseudomonas aeruginosa</i> biofilm killing beyond the spacer by antibiotic-loaded calcium sulfate beads: an in vitro study.","authors":"Jacob R Brooks,&nbsp;Devendra H Dusane,&nbsp;Kelly Moore,&nbsp;Tripti Gupta,&nbsp;Craig Delury,&nbsp;Sean S Aiken,&nbsp;Phillip A Laycock,&nbsp;Anne C Sullivan,&nbsp;Jeffrey F Granger,&nbsp;Matthew V Dipane,&nbsp;Edward J McPherson,&nbsp;Paul Stoodley","doi":"10.5194/jbji-6-119-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-119-2021","url":null,"abstract":"<p><p><b>Introduction</b>: Bacterial biofilms are an important virulence factor in chronic periprosthetic joint infection (PJI) and other orthopedic infection since they are highly tolerant to antibiotics and host immunity. Antibiotics are mixed into carriers such as bone cement and calcium sulfate bone void fillers to achieve sustained high concentrations of antibiotics required to more effectively manage biofilm infections through local release. The effect of antibiotic diffusion from antibiotic-loaded calcium sulfate beads (ALCS-B) in combination with PMMA bone cement spacers on the spread and killing of <i>Pseudomonas aeruginosa</i> Xen41 (PA-Xen41) biofilm was investigated using a \"large agar plate\" model scaled for clinical relevance. <b>Methods</b>: Bioluminescent PA-Xen41 biofilms grown on discs of various orthopedic materials were placed within a large agar plate containing a PMMA full-size mock \"spacer\" unloaded or loaded with vancomycin and tobramycin, with or without ALCS-B. The amount of biofilm spread and log reduction on discs at varying distances from the spacer was assessed by bioluminescent imaging and viable cell counts. <b>Results</b>: For the unloaded spacer control, PA-Xen41 spread from the biofilm to cover the entire plate. The loaded spacer generated a 3 cm zone of inhibition and significantly reduced biofilm bacteria on the discs immediately adjacent to the spacer but low or zero reductions on those further away. The combination of ALCS-B and a loaded PMMA spacer greatly reduced bacterial spread and resulted in significantly greater biofilm reductions on discs at all distances from the spacer. <b>Discussion</b>: The addition of ALCS-B to an antibiotic-loaded spacer mimic increased the area of antibiotic coverage and efficacy against biofilm, suggesting that a combination of these depots may provide greater physical antibiotic coverage and more effective dead space management, particularly in zones where the spread of antibiotic is limited by diffusion (zones with little or no fluid motion).</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"6 5","pages":"119-129"},"PeriodicalIF":0.0,"publicationDate":"2021-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8137860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39075886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revision for periprosthetic joint infection rate stratified by seasonality of operation in a national population of total and unicompartmental knee arthroplasty patients: a register-based analysis.","authors":"Julius Tetens Hald,&nbsp;Anne Brun Hesselvig,&nbsp;Andreas Kryger Jensen,&nbsp;Anders Odgaard","doi":"10.5194/jbji-6-111-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-111-2021","url":null,"abstract":"<p><p><b>Aim</b>: The aim of this study was to investigate whether the revision rate for periprosthetic joint infection (PJI) depends on the season of the primary procedure using a national population of knee arthroplasty (KA) patients. Seasonal variation of some surgical procedures has been observed to impact subsequent infection risks, with a higher risk of revision for surgeries performed during summer, but an analysis of PJI rates based on a national arthroplasty register has yet to be completed. We hypothesized that an increased risk of revision due to PJI could be demonstrated in a national population when primary surgery was performed during the summer. <b>Methods</b>: The Danish Knee Arthroplasty Registry (DKR) was used to determine the risk of revision due to PJI within 2 years after primary surgery. All primary KA procedures between 1 January 1997 and 31 December 2014 and revisions until 31 December 2016 were identified. Smoothing spline regression was used to identify possible seasonal pattern effects of the primary procedure on revision risk, and logistic regression was used to calculate risk of infection differences between seasons. <b>Results</b>: A total number of 124 809 primary procedures was registered in the study period. After excluding duplicates and matching primary procedures with the first revisions within 2 years after the primary procedure, 3391 were identified. Of these, 348 cases were recorded with an indication of deep infection requiring revision. Spline regression analyses did not demonstrate any clear seasonal pattern of the primary procedure regarding the risk of revision for infection or any other cause. Logistic regression found a decreased risk of revision for infection when the primary procedure was performed during the summer in the years 1997 to 2005, no influence on the risk of revision for infection in 2005 to 2012, and an increased risk of revision for infection following summer procedures during the years 2013 to 2014. <b>Conclusion</b>: It was not possible to demonstrate a consistent seasonal variation of the risk of revision for PJI following primary KA. This is most likely because the underlying etiologies for PJI are not subject to seasonal variation.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"6 5","pages":"111-117"},"PeriodicalIF":0.0,"publicationDate":"2021-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8129906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39075885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Mycobacterium bovis</i> BCG osteoarticular infection complicating immune therapy for bladder cancer: a case report.","authors":"Rebecca Stern,&nbsp;Clay Roscoe,&nbsp;Elizabeth A Misch","doi":"10.5194/jbji-6-107-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-107-2021","url":null,"abstract":"<p><p>Osteoarticular infection with <i>Mycobacterium bovis</i> (<i>M. bovis</i>) is a rare complication of bladder cancer treatment with intravesical Bacillus Calmette-Guèrin (BCG). We describe a case of disseminated <i>Mycobacterium bovis</i> BCG infection masquerading as a chronic prosthetic joint infection in a patient with several risk factors for progressive mycobacterial infection.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"6 4","pages":"107-110"},"PeriodicalIF":0.0,"publicationDate":"2021-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8129905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39075884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vancomycin bone and tissue concentrations following tibial intraosseous administration - evaluated in a porcine model.","authors":"Josephine Olsen Kipp,&nbsp;Pelle Hanberg,&nbsp;Josefine Slater,&nbsp;Line Møller Nielsen,&nbsp;Stig Storgaard Jakobsen,&nbsp;Maiken Stilling,&nbsp;Mats Bue","doi":"10.5194/jbji-6-99-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-99-2021","url":null,"abstract":"<p><p><b>Introduction</b>. Systemic perioperative vancomycin may not provide sufficient prophylactic target-site concentrations in the prevention of prosthetic joint infections. Intraosseous vancomycin potentially provides high target-site concentrations. The objective of the present study was to evaluate the local bone and tissue concentrations following tibial intraosseous vancomycin administration in a porcine model. <b>Methods</b>. Eight pigs received 500 mg diluted vancomycin (50 mg/mL) through an intraosseous cannula into the proximal tibial cancellous bone. No tourniquet was applied. Microdialysis was applied for sampling of vancomycin concentrations in adjacent tibial cancellous bone, in cortical bone, in the intramedullary canal of the diaphysis, in the synovial fluid of the knee joint, and in the subcutaneous tissue. Plasma samples were obtained as a systemic reference. Samples were collected for 12 h. <b>Results</b>. High vancomycin concentrations were found in the tibial cancellous bone with a mean peak drug concentration of 1236 (range 28-5295)  <math><mrow><mi>µ</mi> <mi>g</mi> <mo>/</mo> <mi>mL</mi></mrow> </math> , which remained high throughout the sampling period. The mean (standard deviation) peak drug concentration in plasma was 19 (2)  <math><mrow><mi>µ</mi> <mi>g</mi> <mo>/</mo> <mi>mL</mi></mrow> </math> , which was obtained immediately after administration. Peak drug concentration, time to peak drug concentration, and area under the concentration-time curve were within the same range in the intramedullary canal, the synovial fluid of the knee, and the subcutaneous tissue. <b>Conclusion</b>. Tibial intraosseous administration of vancomycin provided high concentrations in tibial cancellous bone throughout a 12 h period but with an unpredictable and wide range of peak concentration. The systemic absorption was high and immediate, thus mirroring an intravenous administration. Low mean concentrations were found in all the remaining compartments.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"6 4","pages":"99-106"},"PeriodicalIF":0.0,"publicationDate":"2021-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8129907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39075883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fluorescent tetracycline bone labeling as an intraoperative tool to debride necrotic bone during septic hip revision: a preliminary case series.","authors":"Ernesto Muñoz-Mahamud,&nbsp;Jenaro Ángel Fernández-Valencia,&nbsp;Andreu Combalia,&nbsp;Laura Morata,&nbsp;Álex Soriano","doi":"10.5194/jbji-6-85-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-85-2021","url":null,"abstract":"<p><p>A plausible cause of persistent infection after septic hip revision may be the presence of nonviable osteomyelitic bone. Since surgical excision of these necrotic fragments is often challenging, the use of fluorescent tetracycline bone labeling (FTBL) as an intraoperative tool may pose an additional assessment aid to provide a visual index of surgical debridement. <b>Methods</b>: We present a single-center study performed in a university hospital from January 2018 to June 2020, in which all consecutive cases of chronic hip periprosthetic joint infection (PJI) undergoing revision using FTBL were retrospectively reviewed. In all cases, the patient was under treatment with tetracyclines at the moment of the revision surgery. During the surgery, all bone failing to fluoresce was considered nonviable and thus removed and sent for both culture and histology. <b>Results</b>: We include three cases in which the FTBL technique was used. In all cases, the histopathological examinations of the nonfluorescent removed bone were consistent with chronic osteomyelitis. <b>Conclusion</b>: The intraoperative use of FTBL successfully aided the surgeon to detect the presence of nonviable bone in all the presented cases of chronic prosthetic hip infection.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"6 4","pages":"85-90"},"PeriodicalIF":0.0,"publicationDate":"2021-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8132458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39075881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One-year infection control rates of a DAIR (debridement, antibiotics and implant retention) procedure after primary and prosthetic-joint-infection-related revision arthroplasty - a retrospective cohort study.","authors":"F Ruben H A Nurmohamed,&nbsp;Bruce van Dijk,&nbsp;Ewout S Veltman,&nbsp;Marrit Hoekstra,&nbsp;Rob J Rentenaar,&nbsp;Harrie H Weinans,&nbsp;H Charles Vogely,&nbsp;Bart C H van der Wal","doi":"10.5194/jbji-6-91-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-91-2021","url":null,"abstract":"<p><p><b>Introduction</b>: Debridement, antibiotics and implant retention (DAIR) procedures are effective treatments for acute postoperative or acute hematogenous periprosthetic joint infections. However, literature reporting on the effectiveness of DAIR procedures performed after a one- or two-stage revision because of a prosthetic joint infection (PJI) (PJI-related revision arthroplasty) is scarce. The aim of this study is to retrospectively evaluate the infection control after 1 year of a DAIR procedure in the case of an early postoperative infection either after primary arthroplasty or after PJI-related revision arthroplasty. <b>Materials and methods</b>: All patients treated with a DAIR procedure within 3 months after onset of PJI between 2009 and 2017 were retrospectively included. Data were collected on patient and infection characteristics. All infections were confirmed by applying the Musculoskeletal Infection Society (MSIS) 2014 criteria. The primary outcome was successful control of infection at 1 year after a DAIR procedure, which was defined as the absence of clinical signs, such as pain, swelling, and erythema; radiological signs, such as protheses loosening; or laboratory signs, such as C-reactive protein (CRP) ( <math><mrow><mo><</mo> <mn>10</mn></mrow> </math> ) with no use of antibiotic therapy. <b>Results</b>: Sixty-seven patients were treated with a DAIR procedure (41 hips and 26 knees). Successful infection control rates of a DAIR procedure after primary arthroplasty ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>51</mn></mrow> </math> ) and after prior PJI-related revision arthroplasty ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>16</mn></mrow> </math> ) were 69 % and 56 %, respectively ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.38</mn></mrow> </math> ). The successful infection control rates of a DAIR procedure after an early acute infection ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>35</mn></mrow> </math> ) and after a hematogenous infection ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>16</mn></mrow> </math> ) following primary arthroplasty were both 69 % ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>1.00</mn></mrow> </math> ). <b>Conclusion</b>: In this limited study population, no statistically significant difference is found in infection control after 1 year between DAIR procedures after primary arthroplasty and PJI-related revision arthroplasty.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"6 4","pages":"91-97"},"PeriodicalIF":0.0,"publicationDate":"2021-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8129908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39075882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bioactive glass S53P4 vs. autologous bone graft for filling defects in patients with chronic osteomyelitis and infected non-unions - a single center experience.","authors":"Eva Steinhausen,&nbsp;Rolf Lefering,&nbsp;Martin Glombitza,&nbsp;Nikolaus Brinkmann,&nbsp;Carsten Vogel,&nbsp;Bastian Mester,&nbsp;Marcel Dudda","doi":"10.5194/jbji-6-73-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-73-2021","url":null,"abstract":"<p><p><b>Introduction</b>: The goals of osteomyelitis therapy are successful control of infection and reconstruction of the bone. The gold standard for filling defects is the autologous bone graft. Bioactive glass S53P4 is an inorganic bone substitute. We compared the outcome of using bioactive glass (BAG) versus autologous bone graft (AB) in patients with infected non-union. <b>Methods</b>: Patients with chronic osteomyelitis and infected non-union who received either bioactive glass or autologous bone grafts between 2013 and 2017 were analyzed retrospectively. The primary endpoint was successful control of infection during follow-up. Secondary endpoints were bone healing, functional outcome, and occurrence of complications. <b>Results</b>: Eighty-three patients were analyzed (BAG <math><mrow><mi>n</mi> <mo>=</mo> <mn>51</mn></mrow> </math> , AB <math><mrow><mi>n</mi> <mo>=</mo> <mn>32</mn></mrow> </math> ). Twenty-one patients experienced reinfection (BAG <math><mrow><mi>n</mi> <mo>=</mo> <mn>15</mn></mrow> </math> , 29 %; AB <math><mrow><mi>n</mi> <mo>=</mo> <mn>6</mn></mrow> </math> , 19 %). Seventy-eight patients achieved full weight bearing (BAG <math><mrow><mi>n</mi> <mo>=</mo> <mn>47</mn></mrow> </math> , 92 %; AB <math><mrow><mi>n</mi> <mo>=</mo> <mn>31</mn></mrow> </math> , 97 %). Sixty-four patients had complete bone healing at the end of the follow-up period (BAG <math><mrow><mi>n</mi> <mo>=</mo> <mn>39</mn></mrow> </math> , 77 %; AB <math><mrow><mi>n</mi> <mo>=</mo> <mn>25</mn></mrow> </math> , 78 %). There were no significant differences between the groups with respect to the primary or secondary endpoints. Patients with multidrug-resistant pathogens had a significantly higher rate of incomplete bone healing ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0</mn></mrow> </math> .033) and a 3-fold higher risk of complications in both groups. <b>Conclusions</b>: Bioactive glass appears to be a suitable bone substitute not only for successful control of infection and defect filling but also for bone healing in cases of infected non-union. In our study, bioactive glass was neither superior nor inferior to autologous bone graft with regard to the primary and secondary endpoints. Further studies with larger numbers of patients are required.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"6 4","pages":"73-83"},"PeriodicalIF":0.0,"publicationDate":"2021-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8132459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39075880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of the gastrocnemius flap performed by orthopaedic surgeons in salvage revision knee arthroplasty.","authors":"Robert Allan McCulloch,&nbsp;Amirul Adlan,&nbsp;Scott Evans,&nbsp;Michael Parry,&nbsp;Jonathan Stevenson,&nbsp;Lee Jeys","doi":"10.5194/jbji-6-425-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-425-2021","url":null,"abstract":"<p><p><b>Introduction</b>: The gastrocnemius myofascial flap is used to manage soft-tissue defects over the anterior aspect of the knee in the context of a patient presenting with a sinus and periprosthetic joint infection (PJI) or extensor mechanism failure. The aim of this study was twofold: firstly, to evaluate the outcomes of gastrocnemius flaps performed by appropriately trained orthopaedic surgeons in the context of PJI and, secondly, to evaluate the infection-free survival of this patient group. <b>Patients and methods</b>: We retrospectively reviewed 30 patients who underwent gastrocnemius flap reconstruction during staged revision total knee arthroplasty for prosthetic joint infection (PJI). All flaps were performed by an orthopaedic surgeon with orthoplastics training. Patients had a mean age of 68.9 years (range 50-84) and were followed up for a mean of 50.4 months (range 2-128 months). A total of 29 patients (97 %) were categorized into Musculoskeletal Infection Society (MSIS) local extremity grade 3 (greater than two compromising factors), and 52 % of PJIs were polymicrobial. The primary outcome measure was flap failure, and the secondary outcome measure was recurrent infection. <b>Results</b>: Flap survival was 100 % with no failures or early returns to theatre for flap problems such as necrosis or haematoma. Overall infection-free survival during the study period was 48 % (13 of 27 infected cases). Using limb salvage as the outcome, 77 % (23 of 30 patients) retained the limb. Infection recurrence occurred in 48 % (10 patients) in the type B3 cohort and 67 % (4 patients) in the type C3 cohort ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.65</mn></mrow> </math> ). <b>Conclusions</b>: The surgical technique for a gastrocnemius myofascial flap is reliable and reproducible when performed by appropriately trained orthopaedic surgeons, even in high-risk groups. However, the risks of recurrent infection and amputation remain high within our series due to poor host and extremity factors.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"6 9","pages":"425-432"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9720735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10423250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simultaneous debridement, Ilizarov reconstruction and free muscle flaps in the management of complex tibial infection.","authors":"Max Mifsud,&nbsp;Jamie Y Ferguson,&nbsp;David A Stubbs,&nbsp;Alex J Ramsden,&nbsp;Martin A McNally","doi":"10.5194/jbji-6-63-2020","DOIUrl":"https://doi.org/10.5194/jbji-6-63-2020","url":null,"abstract":"<p><p>Chronic bone infections often present with complex bone and soft tissue loss. Management is difficult and commonly delivered in multiple stages over many months. This study investigated the feasibility and clinical outcomes of reconstruction in one stage. Fifty-seven consecutive patients with chronic osteomyelitis ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>27</mn></mrow> </math> ) or infected non-union ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>30</mn></mrow> </math> ) were treated with simultaneous debridement, Ilizarov method and free muscle flap transfer. 41 patients (71.9 %) had systemic co-morbidities (Cierny-Mader group Bs hosts). Infection was confirmed with strict criteria. 48 patients (84.2 %) had segmental defects. The primary outcome was eradication of infection at final follow-up. Secondary outcomes included bone union, flap survival and complications or re-operation related to the reconstruction. Infection was eradicated in <math><mrow><mn>55</mn> <mo>/</mo> <mn>57</mn></mrow> </math> cases (96.5 %) at a mean follow-up of 36 months (range 12-146). No flap failures occurred during distraction but 6 required early anastomotic revision and 3 were not salvageable (flap failure rate 5.3 %). Bony union was achieved in <math><mrow><mn>52</mn> <mo>/</mo> <mn>57</mn></mrow> </math> (91.2 %) with the initial surgery alone. After treatment of the five un-united docking sites, all cases achieved bony union at final follow-up. Simultaneous reconstruction with Ilizarov method and free tissue transfer is safe but requires careful planning and logistic considerations. The outcomes from this study are equivalent or better than those reported after staged surgery.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"6 3","pages":"63-72"},"PeriodicalIF":0.0,"publicationDate":"2020-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7852407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25341792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}