A Single-Stage Operation in the Treatment of Chronic Osteomyelitis of the Lower Extremity Including Reconstruction with Free Vascularized Iliac Bone Graft and Free-Tissue Transfer

Rhomberg, M.; Frischhut, B.; Ninković, Marina; Schwabegger, Anton H.; Ninković, Milomir

doi:10.1097/01.prs.0000061006.99819.24

Cited by 24 publications

(19 citation statements)

References 29 publications

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“…Two-stage approach with delayed reconstruction phase is often preferred, especially in advanced osteomyelitis stages [4,8], but this has some disadvantages: several surgical procedures prolong patients' morbidity and increase medical costs [17].…”

Section: Discussionmentioning

confidence: 99%

“…Doi et al [7] suggested that one-stage procedure with free vascularized flaps can achieve infection resolution, soft tissues repair and bone union with the same success rate of multi-stage procedures. Rhomberg et al [17] sustained that one-stage reconstruction with vascularized flaps requires precise diagnosis of the defects (size, length and geometry), radical soft and bone tissues debridement sparing vital structures (vessels and nerves), immediate bone and soft-tissue reconstruction with minimal internal bone fixation.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of chronic Osteomyelitis with vascularized bone flaps in one-stage-procedure

Ciclamini

Antonini

Tos

et al. 2020

Handchir Mikrochir plast Chir

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Background Chronic osteomyelitis is a long-standing infection of the bone. Treatment is often combined, using antibiotics and surgery (with radical debridement and secondary or concomitant reconstruction). One-stage management is an alternative approach, with few reported cases in literature. Patients/Material and methods We carried out an observational retrospective multicenter study to evaluate the results of one-stage reconstructions with vascularized bone flaps. We assessed bone and infection healing in 14 cases, with a mean follow-up of 63.6 months. Results: Bone union was obtained in 10 cases (71.4 %) in a mean period of 7.9 months. Nonunion occurred in 4 cases (28.6 %), 2 of them with infection persistence. Bone nonunion risk increases in polymicrobial infections (p = 0.0269) and in compromised hosts (p = 0.0110). Infection healing was achieved in 11 cases (78.6 %). Fistula recurred in 3 cases of forearm osteomyelitis (21.4 %) in 10 months on average. Infection recurrence is associated with polymicrobial infections (p = 0.0378) and is higher in internal fixation and compromised hosts with no statistically significant relation. Conclusions One-stage surgical treatment seems to be an effective approach in selected patients, in particular when an important impairment of local soft tissue and bone exposure are present, and immediate bone coverage with vascularized soft tissue is needed. Most complications occurred in compromised hosts and in patients with polymicrobial cultures. Further research, with comparison between one and two-stage procedures, is needed in order to strengthen the level of evidence.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Treatment of chronic Osteomyelitis with vascularized bone flaps in one-stage-procedure

Ciclamini

Antonini

Tos

et al. 2020

Handchir Mikrochir plast Chir

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“…Especially for severely infected wounds, the focus must be cleared up before transfer of the free iliac flap. 12 In one case in our study, necrosis occurred at the edge of the wound after operation but it healed after dressing change. In another case, hematoma formed in the recipient site and partial skin graft necrosis developed, and the area was then covered with a second free flap.…”

Section: Discussionmentioning

confidence: 88%

Vascularized Iliac Osteomuscular Free Flaps for Composite Soft Tissue and Bone Defects of the Lower Extremity

Kaijun

Dong-feng

Hou

et al. 2009

Annals of Plastic Surgery

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The purpose of this study to evaluate if vascularized iliac osteomuscular free flaps, which use simple iliac graft companied by covering the iliacus muscle in the inner cortex, is a better option for soft tissue and bone defects of the lower extremity. A retrospective review was performed on 7 consecutive patients treated with vascularized iliac osteomuscular free flaps from June 1999 to March 2003. Survival of skin graft transferred onto the surface of the iliacus muscles provided indirect proof for the survival of transferred bone flap. Skin grafts survived completely in 4 cases and partially in 3 cases. The patients were followed up for 8 to 26 months (average, 14 months) and had acceptable contour and function.

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“…[5][6][7][8] In those cases, necessary debridement often causes combined bone and soft tissue defects. There are established techniques for reconstruction of these defects including osteomyocutaneous iliac crest, 7,13-15 osteocutaneous lateral arm flap, 16 free fibula transfer, 9,10 serratus anterior-rib flap, 8,12 and ostomyocutaneous latissimus scapula flap.…”

Section: Discussionmentioning

confidence: 98%

“…[1][2][3][4][5][6][7][8] There are some established procedures for reconstruction of extensive segmental bone defects like the vascularized fibular transfers 9,10 or Ilizarov segmental bone transfer. 11 Other options are the latissimus-scapula free flap, 6 the free composite serratus anterior and rib flap, 8,12 the osteocutaneous iliac crest flap, 7,[13][14][15] or the osteocutaneous lateral arm flap. 16 To maintain the given length of the extremity is a major priority in the process of reconstruction.…”

mentioning

confidence: 99%

Bone, Tendon, and Soft Tissue Reconstruction in One Stage With the Composite Tensor Fascia Lata Flap

Windhofer¹,

Karlbauer²,

Papp³

2009

Annals of Plastic Surgery

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A 46-year-old patient sustained a dia-infracondylar tibial fracture after a ski accident. Open reduction and internal fixation (ORIF) was carried out. After an initially uneventful postoperative course the patient was readmitted because of local and systemic infection signs. Radical surgical debridement was carried out following by Vacuum-Assisted Closure (VAC) therapy. The resulting defect consisted of bone defect of the tibia tuberosity, and complete loss of the patellar tendon and the overlying soft tissue. Reconstruction was carried out with a combined tensor fascia lata (TFL) flap including the TFL muscle with the ilio-tibial tract, vascularized part of the iliac crest and the overlying soft tissue. Bone healing took place without signs of osteomyelitis recurrence, and full weight bearing was possible 4 months after reconstruction. Successful reconstruction of the patellar tendon using the ilio-tibial tract, enables the patient full active knee joint motion. The soft tissue coverage shows stable conditions. The donor site showed inconspicuous healing without pain and normal range of motion of the hip joint. So this composite TFL flap is an interesting flap not only for defects following trauma, but also for combined defects following extensive infections after knee implants.

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A Single-Stage Operation in the Treatment of Chronic Osteomyelitis of the Lower Extremity Including Reconstruction with Free Vascularized Iliac Bone Graft and Free-Tissue Transfer

Cited by 24 publications

References 29 publications

Treatment of chronic Osteomyelitis with vascularized bone flaps in one-stage-procedure

Treatment of chronic Osteomyelitis with vascularized bone flaps in one-stage-procedure

Vascularized Iliac Osteomuscular Free Flaps for Composite Soft Tissue and Bone Defects of the Lower Extremity

Bone, Tendon, and Soft Tissue Reconstruction in One Stage With the Composite Tensor Fascia Lata Flap

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