STAGED TREATMENT OF INFECTIOUS LONG BONE DEFECT IN LOWER EXTREMITY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIUZhong , XUHong , ZHANGZhao , WUMeng ,  TENGYunsheng , TAOShenglin

Department of Traumatic Orthopedics, Xi'an Ordnance Industrial 521. st Hospital, Xi'an Shaanxi, 710065, P. R. China;

Corresponding?author：

TENGYunsheng, Email: csgk521@126.com

Keywords：

Antibiotic-loaded cement; Fibular graft; Bone defect; Staged treatment

DOI：

10.7507/1002-1892.20140263

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the clinical application and effectiveness of antibiotic-loaded cement spacer combined with free fibular graft in the staged treatment of infectious long bone defect in the lower extremity. Methods A retrospective analysis was made on the clinical data from 12 patients with infectious long bone defect in the lower extremity between June 2010 and June 2012. Of the 12 cases, there were 9 males and 3 females with an average age of 33 years (range, 19-46 years), including 3 cases of femoral shaft bone defect, 7 cases of tibial shaft bone defect, and 2 cases of metatarsal bone defect. The causes were traffic accident injury in 7 cases, crashing injury in 3 cases, and machine extrusion injury in 2 cases. The length of bone defect ranged from 6 to 14 cm (mean, 8 cm). The soft tissue defect area ranged from 5.0 cm×3.0 cm to 8.0 cm×4.0 cm companied with tibial shaft and metatarsal bone defect in 9 cases. The sinus formed in 3 femoral shaft bone defects. The time between injury and operation was 1-4 months (mean, 2 months). At first stage, antibiotic-loaded cement spacer was placed in the bone defect after debridement and the flaps were used to repair soft tissue defect in 9 cases; at second stage (6 weeks after the first stage), defect was repaired with free fibular graft (7-22 cm in length, 14 cm on average) after antibiotic-loaded cement spacer removal. The area of the cutaneous fibular flap ranged from 6.0 cm×4.0 cm to 10.0 cm×5.0 cm in 10 cases. Results All wounds healed by first intention, and the healing time was 12-18 days, 14 days on average. Twelve cases were followed up 12-36 months (mean, 17 months). Bone healing time ranged from 4 to 6 months (5.5 months on average). The cutaneous fibular flap had good appearance. The function at donor site was satisfactory; no dysfunction of the ankle joint or tibial stress fracture occurred after operation. The mean Enneking score was 25 (range, 20-28) at last follow-up. Conclusion Infection can be well controlled with the antibiotic-loaded cement spacer during first stage operation, and free fibular graft can increase the bone defect healing rate at second stage. Staged treatment is an optimal choice to treat infectious long bone defect in the lower extremity.

Citation： LIUZhong, XUHong, ZHANGZhao, WUMeng, TENGYunsheng, TAOShenglin. STAGED TREATMENT OF INFECTIOUS LONG BONE DEFECT IN LOWER EXTREMITY. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(10): 1212-1216. doi: 10.7507/1002-1892.20140263 Copy

1.	Bishop AT, Pelzer M.Vascularized bone allotransplantation:current state and implications for future reconstructive surgery.Orthop Clin North Am, 2007, 38(7):109-122, vii.
2.	Aronson J.Limb-lengthening, skeletal reconstruction, and bone transport with the Ilizarov method.J Bone Joint Surg (Am), 1997, 79(8):1243-1258.
3.	Pattyn C, De Geest T, Ackerman P, et al.Preformed gentamicin spacers in two-stage revision hip arthroplasty:functional results and complication.Int Orthop, 2011, 35(10):1471-1476.
4.	Lasaniano NG, Kanakaris NK, Giannoudis PV.Current management of long-bone large segmental defects.Orthop Trauma, 2010, 24(2):149-163.
5.	滕云升, 劉重, 智豐, 等.腓骨骨皮瓣組合股前外側皮瓣修復小腿復合組織缺損.中華顯微外科雜志, 2009, 32(2):116-118.
6.	趙剛, 齊明, 張伯松, 等.慢性骨髓炎的分期治療策略.中國骨與關節外科, 2012, 5(5):416-419.
7.	Zunino JH, Bengochea M, Johnston J, et al.Immunologic and osteogeneic properties of xenogeneic and allogeneic demineralized bone transplants.Cell Tissue Bank, 2004, 5(3):141-148.
8.	Korompilias AV, Paschos NK, Lykissas MG, et al.Recent updates of surgical techniques and applications of free vascularized fibular graft in extremity and trunk reconstruction.Microsurgery, 2011, 31(3):171-175.
9.	Girard PJ, Kuhn KM, Bailey JR, et al.Bone transport combined with locking bridge plate fixation for the treatment of tibial segmental defects:a report of two cases.J Orthop Trauma, 2013, 27(9):220-226.
10.	Buchholz HW, Elson RA, Engelbrecht E, et al.Management of deep infection of total hip replacement.J Bone Joint Surg (Br), 1981, 63-B (3):342-353.
11.	劉相成, 周勇剛, 王巖, 等.自制關節型抗生素骨水泥占位器在人工髖關節置換術后感染二期翻修中的應用.中華外科雜志, 2010, 48(14):1050-1054.
12.	Zuluaga AF, Galvis W, Saldarriaga JG, et al.Etiologic diagnosis of chronic osteomyelitis:a prospective study.Ar Intern Med, 2006, 166(1):95-100.
13.	Pattyn C, De Geest T, Ackerman P, et al.Preformed gentamicin spacers in two-stage revision hip arthroplasty:functional results and complication.Int Orthop, 2011, 35(10):1471-1476.
14.	Giannoudis PV, Faour O, Goff T, et al.Masquelet technique for the treatment of bone defects:tips-tricks and future directions.Injury, 2011, 42(6):591-598.
15.	楊運發, 張光明, 徐中和.下肢創傷后大段感染性骨缺損的分型及修復.中華創傷骨科雜志, 2010, 12(5):417-420.
16.	Van der Veen FJC, Strackee SD, Besselaar PP.Progressive valgus deformity of the donor-site ankle after extraperiosteal harvesting the fibular shaft in children.Treatment with osteotomy and synostosis at one session.J Orthop, 2014, 62(12):48-53.
17.	Makridis KG, Theocharakis S, Fragkakis EM, et al.Reconstruction of an extensive soft tissue and bone defect of the first metatarsal with the use of Masquelet technique:a case report.Foot Ankle Surg, 2013, 20(2):19-22.
18.	滕云升, 王兆杰, 劉重, 等.游離腓骨皮瓣修復前足復合組織缺損.中國修復重建外科雜志, 2013, 27(3):378-379.

1. Bishop AT, Pelzer M.Vascularized bone allotransplantation:current state and implications for future reconstructive surgery.Orthop Clin North Am, 2007, 38(7):109-122, vii.
2. Aronson J.Limb-lengthening, skeletal reconstruction, and bone transport with the Ilizarov method.J Bone Joint Surg (Am), 1997, 79(8):1243-1258.
3. Pattyn C, De Geest T, Ackerman P, et al.Preformed gentamicin spacers in two-stage revision hip arthroplasty:functional results and complication.Int Orthop, 2011, 35(10):1471-1476.
4. Lasaniano NG, Kanakaris NK, Giannoudis PV.Current management of long-bone large segmental defects.Orthop Trauma, 2010, 24(2):149-163.
5. 滕云升, 劉重, 智豐, 等.腓骨骨皮瓣組合股前外側皮瓣修復小腿復合組織缺損.中華顯微外科雜志, 2009, 32(2):116-118.
6. 趙剛, 齊明, 張伯松, 等.慢性骨髓炎的分期治療策略.中國骨與關節外科, 2012, 5(5):416-419.
7. Zunino JH, Bengochea M, Johnston J, et al.Immunologic and osteogeneic properties of xenogeneic and allogeneic demineralized bone transplants.Cell Tissue Bank, 2004, 5(3):141-148.
8. Korompilias AV, Paschos NK, Lykissas MG, et al.Recent updates of surgical techniques and applications of free vascularized fibular graft in extremity and trunk reconstruction.Microsurgery, 2011, 31(3):171-175.
9. Girard PJ, Kuhn KM, Bailey JR, et al.Bone transport combined with locking bridge plate fixation for the treatment of tibial segmental defects:a report of two cases.J Orthop Trauma, 2013, 27(9):220-226.
10. Buchholz HW, Elson RA, Engelbrecht E, et al.Management of deep infection of total hip replacement.J Bone Joint Surg (Br), 1981, 63-B (3):342-353.
11. 劉相成, 周勇剛, 王巖, 等.自制關節型抗生素骨水泥占位器在人工髖關節置換術后感染二期翻修中的應用.中華外科雜志, 2010, 48(14):1050-1054.
12. Zuluaga AF, Galvis W, Saldarriaga JG, et al.Etiologic diagnosis of chronic osteomyelitis:a prospective study.Ar Intern Med, 2006, 166(1):95-100.
13. Pattyn C, De Geest T, Ackerman P, et al.Preformed gentamicin spacers in two-stage revision hip arthroplasty:functional results and complication.Int Orthop, 2011, 35(10):1471-1476.
14. Giannoudis PV, Faour O, Goff T, et al.Masquelet technique for the treatment of bone defects:tips-tricks and future directions.Injury, 2011, 42(6):591-598.
15. 楊運發, 張光明, 徐中和.下肢創傷后大段感染性骨缺損的分型及修復.中華創傷骨科雜志, 2010, 12(5):417-420.
16. Van der Veen FJC, Strackee SD, Besselaar PP.Progressive valgus deformity of the donor-site ankle after extraperiosteal harvesting the fibular shaft in children.Treatment with osteotomy and synostosis at one session.J Orthop, 2014, 62(12):48-53.
17. Makridis KG, Theocharakis S, Fragkakis EM, et al.Reconstruction of an extensive soft tissue and bone defect of the first metatarsal with the use of Masquelet technique:a case report.Foot Ankle Surg, 2013, 20(2):19-22.
18. 滕云升, 王兆杰, 劉重, 等.游離腓骨皮瓣修復前足復合組織缺損.中國修復重建外科雜志, 2013, 27(3):378-379.

Chinese Journal of Reparative and Reconstructive Surgery

STAGED TREATMENT OF INFECTIOUS LONG BONE DEFECT IN LOWER EXTREMITY

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content