Chronic Open Infective Lateral Malleolus Bursitis Management Using Local Rotational Flap

Abstract

Background Using a sinus tarsi rotational flap is an uncommon approach to treating chronic open infective lateral malleolus bursitis. Methods We treated eight patients, including six males, using this approach. First, we debrided all the infected tissues and used a negative pressure wound closure system where needed. After acute infection had been controlled, the local rotational flap was used for cases where the wound could not be closed by a simple suture or bone exposure. The rotational flap was detached with a curved skin incision at the sinus tarsi next to the open wound and sutured to the defect, paying careful attention to the superficial peroneal nerve. The donor site was managed with a split-thickness skin graft. Results The patients' mean age was 74.1 years. Six patients had a wound after suppurative infection, but two patients had ulcer-type bursitis. Six patients demonstrated full flap healing, but two patients had venous congestion necrosis. Conclusion A sinus tarsi rotational flap is a useful method to ensure healing and coverage of chronic open lateral malleolus bursitis, especially for small to medium wounds with cavity and bone exposure.

Effects of Inflammatory Disease on Clinical Progression and Treatment of Ischiogluteal Bursitis: A Retrospective Observational Study

“…Occupation, trauma history, sitting lifestyle and time, and obesity, commonly considered causal in IGB, could not be observed for statistical significance with non-response IGB 29 , 30 . Patients with underlying inflammatory diseases, such as rheumatoid arthritis, gout, and skin infection, showed less responsiveness to conservative management, and two of the patients in our study required open surgical intervention due to failure of medical treatment 9 ,31 . Therefore, underlying inflammatory diseases in IGB patients is an important factor to consider in treatment response and patient education.…”

“…In this study, if the pain VAS did not improve by more than 50% and persisted for more than six months despite conservative and injection treatment, and when surgical treatment was required, the patient was defined as 'nonresponse IGB'. Conversely, when symptoms improved by conservative and injection treatment, the patient was defined as a ‘response IGB’ 9 .…”

Candy Closure Technique for Chronic Open Infective Lateral Malleolus Bursitis

“…The area around the lateral malleolus is weaker because of the high pressure it sustains. This high pressure is usually generated by the cross-legged position common in specific regions or by general weakness induced by external rotation of the hip [6]. Because lateral malleolar bursitis recurrence is common, several studies on treatment methods aiming to address bursitis without recurrence have been reported such as indwelling silk suture [13], endoscopic bursectomy [4], and sclerotherapy [14].…”

“…For such reconstruction, several types of flaps including local flaps, regional flaps, and free flaps have been used. However, flap surgery has disadvantages, as it leaves a big scar and needs additional graft surgery [6]. If the flap surgery is successful, there is a possibility of pressure ulcer when shoes are worn because the flap tissue is thick.…”

“…However, the recurrence rate is high [5], and infection may occur during treatment. When infection develops, the bone may become exposed because of the thin overlying soft tissue [6]. It becomes intractable in compromised patients with abnormal sensation or circulatory disturbance in the legs.…”