Three-Stage Masquelet Technique and One-Stage Reconstruction to Treat Foot and Ankle Tuberculosis

Abstract

Background: The purpose of this article was to report the feasibility and effectiveness of 3-stage Masquelet technique and 1-stage operation for different stages of foot and ankle tuberculosis (TB). Methods: Ten consecutive patients with foot and ankle TB were retrospectively analyzed between January 2014 and December 2018. Five patients were treated with the 3-stage Masquelet technique, including thorough debridement with vacuum sealing drainage, implantation of antibiotic cement spacer, and subsequent reconstruction. Five patients were treated with a 1-stage reconstruction. The American Orthopaedic Foot & Ankle Society (AOFAS) and visual analog scale (VAS) pain scores were recorded at the last follow-up. The follow-up was 30.3 ± 17.8 months. Results: No reactivation of TB was observed in any patients. For the 3-stage operation group, 1 patient developed a distal tibia fracture. The duration of anti-TB therapy was 12.0 ± 0.8 months. The AOFAS score increased from 39.5 ± 9.9 preoperatively to 75.3 ± 7.0 postoperatively ( P < .05). The VAS pain score decreased from 6.3 ± 1.9 to 1.5 ± 1.3 ( P < .05). For the 1-stage operation, 1 patient had wound necrosis. The duration of anti-TB therapy was 13.8 ± 1.1 months. The AOFAS score increased from 51.8 ± 15.0 to 81.8 ± 6.3 ( P < .05). The VAS pain score decreased from 5.4 ± 1.1 to 1.0 ± 0.7 ( P < .05). Conclusion: Three-stage operation was effective for foot and ankle TB with stage IV, sinus tracts or other infections, and 1-stage reconstruction was effective for early-stage TBs. Level of Evidence: Level IV, case series.

Modified Masquelet Technique Assisting 3D Printed Elbow Prosthesis for Open Elbow Fracture with Severe Bone Defect: A Case Report and Technique Note

“…It could successfully control or eradicate bone infection and facilitate defect reconstruction. Its effectiveness for treating infectious bone defects in the lower extremity had been testified 20 . High‐concentration antibiotics locally released from bone cement effectively interfere with bacterial colonization and bacterial membrane formation.…”

PMMA Bone Cement Composite Functions as an Adjuvant Chemotherapeutic Platform for Localized and Multi‐Window Release during Bone Reconstruction

“…[48][49][50][51] Patients are generally only partially weightbearing while the PMMA spacer is in place. [48][49][50][51] Therefore, for the application of the PMMA composite as a temporary spacer, a slightly decreased compressive strength upon implantation does not prohibit its used in this application. Additionally, since PMMA composites continually strengthen over time (see Figures S2 and S3, Supporting Information), possibly reflecting reaction of residual monomers and/or oligomers, the PMMA/10wt%CD-DOX and PMMA/15wt%CD-DOX exceed the 70 MPa threshold over time following implantation.…”

“…48 h post-fabrication, plain PMMA and PMMA/1.25wt%Free-DOX exceeded the 70 MPa threshold, whereas PMMA/15wt%CD-DOX fell slightly short of this cutoff (by 6.6 MPa). Nevertheless, weight-bearing following the placement of the temporary spacer is highly dependent upon the location of the spacer, size of the defect, and if the spacer is supported with any metallic hardware [48][49][50][51]. Patients are generally only partially weightbearing while the PMMA spacer is in place [48][49][50][51].…”

“…Nevertheless, weight-bearing following the placement of the temporary spacer is highly dependent upon the location of the spacer, size of the defect, and if the spacer is supported with any metallic hardware [48][49][50][51]. Patients are generally only partially weightbearing while the PMMA spacer is in place [48][49][50][51]. Therefore, for the application of the PMMA composite as a temporary spacer, a slightly decreased compressive strength upon implantation does not prohibit its used in this application.…”

Negative pressure promotes macrophage M1 polarization after Mycobacterium tuberculosis infection via the lncRNA XIST/microRNA–125b–5p/A20/NF–κB axis

“…Prior research shows that vacuum sealing drainage (VSD) treatment can be effective in promoting the healing of TB wounds with sinus tracts 18,19 . Moreover, a recent study showed the benefits of applying the three‐stage Masquelet technique (debridement with VSD, antibiotic cement spacer, and subsequent reconstruction) in TB of the foot and ankle with sinus tracts 20 . Importantly, stimulation by negative pressure can promote cell viability in polymorphonuclear neutrophils (PMNs) and macrophages to trigger inflammatory responses and induce epithelialization during wound healing 21 .…”