Application of antibiotic bone cement combined with d-LCFA lobulated perforator flap in treatment of infected tissue defects of foot under the guidance of ERAS concept

Abstract

Objective To evaluate the clinical efficacy of antibiotic bone cement combined with lobulated perforator flap based on the descending branch of lateral circumflex femoral artery (d-LCFA) in treating infected tissue defects of the foot under the guidance of ERAS concept. Methods From December 2019 to November 2022, 10 patients with infected tissue defects of the foot were treated with antibiotic bone cement combined with d-LCFA lobulated perforator flap. This cohort comprised 6 males and 4 females, aged 21 to 67 years. All 10 cases underwent debridement and antibiotic bone cement coverage to control infection, with 9 cases undergoing debridement once and one case undergoing debridement twice. After infection control, the d-LCFA lobulated perforator flap was used to repair the tissue defects of the foot, and the donor site was sutured primarily. The flap area ranged from 12 cm×6 cm to 31 cm×7 cm. The follow-up included an evaluation of flap survival, donor site healing, and ambulatory function of the foot. Results The follow-up period ranged from 7 to 24 months, averaging 14 months. Infection control was successful in all cases. The flaps had excellent survival rates, and the donor site healed by first intention. Based on the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, pain and function were evaluated as excellent in 3 cases, good in 5 cases, and moderate in 2 cases. Conclusion The application of antibiotic bone cement combined with d-LCFA lobulated perforator flap is an effective method for infected tissue defects of the foot with the advantages of simplicity, high repeatability, and exact curative effects. The application of d-LCFA lobulated perforator flap in wound repair reduces iatrogenic injury, shortens hospital stays, lowers medical expenses, and accelerates patient rehabilitation, aligning with the ERAS concept. Therefore, it is a practice worth promoting in clinical use.