Chronic osteomyelitis

Simpson, A. H. R. W.; Deakin, Mark; Latham, Jeremy M.

doi:10.1302/0301-620x.83b3.0830403

Cited by 90 publications

(24 citation statements)

References 12 publications

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“…The third comparative study from Simpson et al [4] reviewed the impact of extensive versus marginal debridement with dead space management compared to minimal debridement and no dead space management strategy. Wider debridement had a higher non-recurrence rate (100%, N = 8) compared to marginal debridement (71.4%, N = 21) [both with dead space management] versus minimal debridement (0%, N = 4: all host type C) [MCMS = 75].…”

Section: Resultsmentioning

confidence: 99%

A systematic review of the single-stage treatment of chronic osteomyelitis

et al. 2019

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BackgroundDespite advances in surgery, the treatment of chronic osteomyelitis remains complex and is often associated with a significant financial burden to healthcare systems. The aim of this systematic review was to identify the different single-stage procedures that have been used to treat adult chronic osteomyelitis and to evaluate their effectiveness.MethodsOvid Medline and Embase databases were searched for articles on the treatment of chronic osteomyelitis over the last 20 years. A total of 3511 journal abstracts were screened by 3 independent reviewers. Following exclusion of paediatric subjects, animal models, non-bacterial osteomyelitis and patients undergoing multiple surgical procedures, we identified 13 studies reported in English with a minimum follow-up period of 12 months. Data extraction and quality assessment were performed for all studies. Non-recurrence was defined as resolution of pain without recurrence of sinuses or need for a second procedure to treat infection within the described follow-up period.ResultsA total of 505 patients with chronic osteomyelitis underwent attempted single-stage procedures. Following debridement, a range of techniques have been described to eliminate residual dead space including biologic and non-biologic approaches. These include musculocutaneous flaps, insertion of S53P4 glass beads or packing with antibiotic-loaded ceramic or calcium-sulphate pellets. The average follow-up ranged from 12 to 110 months. The most common organism isolated was Staphylococcus aureus (35.2%). Non-recurrence ranged from 0 to 100%. Debridement alone was statistically significantly inferior to approaches that included dead space management (54.5% versus 90% non-recurrence). Biologic and non-biologic approaches to dead space management were comparable (89.8% versus 94.2% non-recurrence).ConclusionA wide range of single-stage procedures have been performed for the treatment of chronic osteomyelitis. In general, studies were small and observational with various reporting deficiencies. No one dead space management technique appears to be superior, but debridement alone that leaves residual dead space should be avoided.

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Section: Resultsmentioning

confidence: 99%

A systematic review of the single-stage treatment of chronic osteomyelitis

et al. 2019

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“…The quality of debridement of bone infection is a key factor influencing infection, and hence of the outcome of any reconstructive approach [21]. Adjuvant antibiotic therapy may mask the effect of an inadequate debridement by suppressing but not eradicating any resultant infection [14].…”

Section: Discussionmentioning

confidence: 99%

“…A potentially curative surgery should ideally involve a wide resection of the infected tissues with a safety margin (at least 5 mm.) to ensure eradication of infection [18][19][20][21].…”

Section: Discussionmentioning

confidence: 99%

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Definition of Bone Transport from an Orthoplastic Perspective

El-Rosasy

Mahmoud

El-Gebaly

et al. 2019

International Journal of Orthoplastic Surgery

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Introduction Tibial fractures are more apt to be complicated with bone and soft tissue loss either due to the severity of injury, in open fractures, or after debridement of infected fractures. Reconstruction of traumatic composite bone and soft tissue loss (TCBSTL) employs several approaches, among which is the bone transport (BT) [1, 2]. In this procedure a healthy bone segment is mobilized by means of an external fixator to bridge a bone gap [3-8]. Mobilization of the bone segment entails advancement of a bone segment and the overlying soft tissue envelop altogether to bridge the tissue gap. Most published articles on BT have focused on the mobilization of a bone segment; but little attention has been paid to the ability of the transport to effectively close the skin defect without the need for soft tissue flaps whether local or free flaps [9-11]. Several authors have recommended doing primary soft tissue flaps to reconstruct soft tissue defects followed by bone reconstruction in a two-stage procedure [2, 6, 12-16]. When conceived as an advancement of a local composite tissue flap, bone transport could obviate the need for unnecessary flaps to cover skin defects and allows both soft tissue and bone reconstruction in one-stage procedure. This study presents the results of distraction histogenesis and redefines "bone transport" as a procedure of "local tissue transport" for the management of traumatic composite bone and soft tissue loss of the leg and ankle. Patients and Methods This work has been reported in line with the STROCSS criteria (Strengthening the Reporting of Cohort Studies in Surgery) [17]. And has been registered in the research registry (Research Registry UIN: researchregistry4819). Study Design A retrospective single center cohort study of 150 cases treated between the year 2000 and 2017 by the same operative team. Inclusion and Exclusion Criteria Patients with reconstructable post-traumatic composite bone and soft tissue loss of the leg were included in the study. Patients who were not candidates for limb reconstruction using external skeletal fixation due to intoler

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“…The endpoints of curative approach to deep foot ulcer and osteomyelitis are: Radical surgical resection, including healthy bone and soft tissue, is sometimes required and must follow an "oncologic approach" in the case of deep foot infections and OM [29,30], since they are difficult to treat and they could relapse.…”

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confidence: 99%

Diabetic Foot Infections: The Diagnostic Challenges

Lauri

Leone

Cavallini

et al. 2020

JCM

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Diabetic foot infections (DFIs) are severe complications of long-standing diabetes, and they represent a diagnostic challenge, since the differentiation between osteomyelitis (OM), soft tissue infection (STI), and Charcot’s osteoarthropathy is very difficult to achieve. Nevertheless, such differential diagnosis is mandatory in order to plan the most appropriate treatment for the patient. The isolation of the pathogen from bone or soft tissues is still the gold standard for diagnosis; however, it would be desirable to have a non-invasive test that is able to detect, localize, and evaluate the extent of the infection with high accuracy. A multidisciplinary approach is the key for the correct management of diabetic patients dealing with infective complications, but at the moment, no definite diagnostic flow charts still exist. This review aims at providing an overview on multimodality imaging for the diagnosis of DFI and to address evidence-based answers to the clinicians when they appeal to radiologists or nuclear medicine (NM) physicians for studying their patients.

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Chronic osteomyelitis

Cited by 90 publications

References 12 publications

A systematic review of the single-stage treatment of chronic osteomyelitis

A systematic review of the single-stage treatment of chronic osteomyelitis

Definition of Bone Transport from an Orthoplastic Perspective

Diabetic Foot Infections: The Diagnostic Challenges

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