One-stage reconstruction with open bone grafting and vacuum-assisted closure for infected tibial non-union

Abstract

IntroductionNon-union of the tibia complicated by osteomyelitis is one of the most challenging problems in orthopaedic surgery. There remains a significant amount of debate and controversy regarding the optimal medical management of infected tibial non-union. There are few articles which have reported the outcomes of treatment for infected non-union of tibia from single-stage reconstruction with open bone grafting plus vacuum-assisted closure (VAC).Material and methodsOur report covers experience between March 2007 and February 2010 of open bone grafting plus VAC in one stage for patients with infected tibial non-union. The time for bone union and wound healing to occur, the duration of hospitalisation, and the rate of resolution of infection were all analysed. The main outcome measures were based on a clinical scoring system that assessed functional ability, range of knee and ankle motion, shortening, infection and pain. Fifteen patients were involved in this study.ResultsAll patients were followed up for an average of 22.6 months (range: 14–42 months). Bone union was achieved in 93.3% (14/15) of patients after a mean of 5.93 months (range: 3–10 months). All wounds healed within an average period of 5 weeks (range: 3–10 weeks), and the function and appearance of all limbs were satisfactory.ConclusionsOpen bone grafting combined with VAC in a one-stage procedure can be a feasible alternative to the treatment of infected tibial non-union, especially for those wounds which are not good candidates for microsurgery; however, further studies are required to confirm the likely benefits.

Use of cancellous bone grafting to promote granulation tissue in a distal limb wound in a dog

“…It has also been used in combination with open bone grafting to treat septic non‐union fractures in humans but may not be available in every veterinary hospital ( Deng et al . ). Topical medications to enhance wound healing include Manuka honey, platelet rich plasma, and growth factors ( Bischofberger et al .…”

“…NPWT has been shown to promote early granulation tissue formation when used for the first 10 days after wound creation on the distal limb (Demaria et al 2011). It has also been used in combination with open bone grafting to treat septic non-union fractures in humans but may not be available in every veterinary hospital (Deng et al 2014). Topical medications to enhance wound healing include Manuka honey, platelet rich plasma, and growth factors (Bischofberger et al 2013, Karayannopoulou et al 2015.…”

“…, Deng et al . ). In the case of a shear wound to the distal extremity, bone graft can similarly be placed within the wound bed to promote granulation tissue formation over exposed tendons and bone and reduce the time to wound closure.…”

“…Placement of bone graft within the wound is followed rapidly by vascular ingrowth and coverage with healthy granulation tissue. This results in reduced time until the wound can be treated by primary skin closure or placement of a skin graft resulting in a reduction in total treatment time (Graebner et al 1983, Deng et al 2014). In the case of a shear wound to the distal extremity, bone graft can similarly be placed within the wound bed to promote granulation tissue formation over exposed tendons and bone and reduce the time to wound closure.…”

Surgical management of infected non-unions: An update

“…Usually, this strategy is followed when the fixation is stable and the infection is diagnosed at the early period (i.e. referring rather to a delayed union scenario or an acute surgical site infection), or in exceptional frail patients with limited ambulation and needs, where a more aggressive strategy cannot be followed [16,[49][50][51][52].…”