Treatment options for infected bone defects in the lower extremities: free vascularized fibular graft or Ilizarov bone transport?

Ren, Gao-hong; Li, Runguang; Hu, Yanjun; Chen, Yirong; Chen, Chaojie; Yu, Bin

doi:10.1186/s13018-020-01907-z

Cited by 28 publications

(24 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The rate of infection recurrence was 4.8% in the DRD group and 14.5% in the Ilizarov group. Several studies with modest sample sizes have also shown very low recurrence when utilizing the 1-stage Ilizarov bone transport technique, with rates ranging from 4.7% to 9.1% 16,40,45,46 . In a study of 149 cases of tibial osteomyelitis treated with the Ilizarov bone transport technique, Yalikun et al reported an infection recurrence rate of 11.4% 47 , which was consistent with the findings of the present study.…”

Section: Discussionmentioning

confidence: 99%

“…Orthopaedic surgeons face various problems when treating osteomyelitis, such as the considerable rate of infection recurrence, need for extensive debridement, soft-tissue coverage, reconstruction of bone defects, and postoperative complications. Therefore, despite the reported use of varied surgical techniques for osteomyelitis, such as the Papineau technique 6-10 , the Masquelet technique 11-15 , and vascularized bone grafts 16-18, 19 20, 21 , the optimal treatment remains controversial.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Debridement-Reconstruction-Docking Management System Versus Ilizarov Technique for Lower-Extremity Osteomyelitis

Ren,

Cai,

et al. 2023

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

Background: Osteomyelitis causes marked disability and is one of the most challenging diseases for orthopaedists to treat because of the considerable rate of infection recurrence. In this study, we proposed and assessed the debridement-reconstruction-docking (DRD) system for the treatment of lower-extremity osteomyelitis. This procedure comprises 3 surgical stages and 2 preoperative assessments; namely, pre-debridement assessment, debridement, pre-reconstruction assessment, reconstruction, and docking-site management. We evaluated the use of the DRD system compared with the Ilizarov technique, which is defined as a 1-stage debridement, osteotomy, and bone transport. Methods: This retrospective cohort included 289 patients who underwent either DRD or the Ilizarov technique for the treatment of lower-extremity osteomyelitis at a single institution between January 2013 and February 2021 and who met the eligibility criteria. The primary outcome was the rate of infection recurrence. Secondary outcomes included the external fixator index (EFI), refracture rate, and the Paley classification for osseous and functional results. An inverse-probability-weighted regression adjustment model was utilized to estimate the effect of the DRD system and Ilizarov technique on the treatment of lower-extremity osteomyelitis. Results: A total of 131 and 158 patients underwent DRD or the Ilizarov technique, respectively. The inverse-probability-weighted regression adjustment model suggested that DRD was associated with a significant reduction in infection recurrence (risk ratio [RR], 0.26; 95% confidence interval [CI], 0.13 to 0.50; p < 0.001) and EFI (−6.9 days/cm, 95% CI; −8.3 to −5.5; p < 0.001). Patients in the DRD group had better Paley functional results than those in the Ilizarov group (ridit score, 0.55 versus 0.45; p < 0.001). There was no significant difference between the 2 groups in the rate of refracture (RR, 0.87; 95% CI, 0.42 to 1.79; p = 0.71) and Paley osseous results (ridit score, 0.51 versus 0.49; p = 0.39). Conclusions: In this balanced retrospective cohort of patients with lower-extremity osteomyelitis, the use of the DRD system was associated with a reduced rate of infection recurrence, a lower EFI, and better Paley functional results compared with the use of the Ilizarov technique. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Debridement-Reconstruction-Docking Management System Versus Ilizarov Technique for Lower-Extremity Osteomyelitis

Ren,

Cai,

et al. 2023

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

show abstract

“…The most common complications of segmental bone defect repair include infection, rejection reaction, bone nonunion, bone graft fracture, etc 46 . Therefore, Ilizarov technology combined with vascularized autogenous bone graft is considered to be an effective method to deal with large segmental bone defects.…”

Section: Application In Infected Bone Defectsmentioning

confidence: 99%

“…The most common complications of segmental bone defect repair include infection, rejection reaction, bone nonunion, bone graft fracture, etc. 46 Therefore, Ilizarov technology combined with vascularized autogenous bone graft is considered to be an effective method to deal with large segmental bone defects. El‐Alfy et al 47 used Ilizarov bone transport technology to treat 28 patients with infected bone defects combined with soft tissue defects, and the average length of bone defects was 8 cm, among which 13 patients had no bone grafting and 15 patients had cancellous bone grafting.…”

Section: Application In Infected Bone Defectsmentioning

confidence: 99%

Evolution and Development of Ilizarov Technique in the Treatment of Infected Long Bone Nonunion with or without Bone Defects

Wang

et al. 2022

Orthopaedic Surgery

View full text Add to dashboard Cite

The treatment of infected bone nonunion and bone defects is a considerable challenge in the orthopedics field. The standard clinical therapy methods include local free bone transplantation, vascularized bone graft, and the Ilizarov technique; the first two are controversial due to the iatrogenic self-injury. The Ilizarov bone transport technique has been widely used to treat infected bone nonunion and bone defects, and good clinical effect has been demonstrated. Yet, it brings many related complications, which exerts additional suffering to the patient. The best treatment is to combine bone defect rehabilitation with infection control, intramedullary nail fixation, appropriate time for bone grafts, beaded type scaffold slippage and new Taylor fixation, reducing the external fixation time and the incidence of complications, thereby reducing the occurrence of patients' physical and psychological problems. This review focuses on the induction, summary and analysis of the Ilizarov bone transport technique in the treatment of infected long bone nonunion with or without bone defects, providing new ideas and methods for orthopedic disease prevention and treatment by the Ilizarov technique, which is following the development direction of digital orthopedics.

show abstract

“…Bone infections following open bone fractures increase the difficulty of defect treatment and functional recovery [ 1 ]. Invading bacteria and other pathogens can colonize the bone and cause the release of osteolytic cytokines, which subsequently leads to bone destruction [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

β-tricalcium phosphate/gelatin composite scaffolds incorporated with gentamycin-loaded chitosan microspheres for infected bone defect treatment

Liu¹,

Zhao²,

Chen³

et al. 2022

PLoS ONE

View full text Add to dashboard Cite

The repair of infected bone defects remains a clinical challenge. Staphylococcus aureus is a common pathogenic micro-organism associated with such infections. Gentamycin (GM) is a broad spectrum antibiotic that can kill S. aureus in a dose-dependent manner. However, the systemic administration of antibiotics may lead to drug resistance and gut dysbiosis. In this work, we constructed β-tricalcium phosphate/gelatin composite scaffolds incorporated with gentamycin-loaded chitosan microspheres (CMs(GM)-β-TCP/gelatin composite scaffolds), which helped optimize the local GM release in the infected defect areas and enhance bone regeneration. The cumulative release curves showed that both microspheres and composite scaffolds reached a sustained slow-release phase after the initial rapid release, and the latter further stabilized the initial drug release rate. The release curve of CMs(GM)-β-TCP/gelatin composite scaffolds reached a plateau after 24 h, and the cumulative release reached 41.86% during this period. Moreover, the combination of β-TCP and gelatin mimicked bone composition and were able to provide the requisite mechanical strength (0.82 ± 0.05 MPa) during the first phase of bone generation. The inner structure of the scaffold was arranged in the shape of interconnected pores, and presented a porosity level of 16%. The apertures were uniform in size, which was beneficial for cell proliferation and material transportation. Macroscopic observation and histological analysis showed that CMs(GM)-β-TCP/gelatin composite scaffolds fused with bone tissues, and new tissues were formed in defect areas without any infection. This new composite scaffold may be a promising repair material for treating infected bone defects.

show abstract

Treatment options for infected bone defects in the lower extremities: free vascularized fibular graft or Ilizarov bone transport?

Cited by 28 publications

References 38 publications

Debridement-Reconstruction-Docking Management System Versus Ilizarov Technique for Lower-Extremity Osteomyelitis

Debridement-Reconstruction-Docking Management System Versus Ilizarov Technique for Lower-Extremity Osteomyelitis

Evolution and Development of Ilizarov Technique in the Treatment of Infected Long Bone Nonunion with or without Bone Defects

β-tricalcium phosphate/gelatin composite scaffolds incorporated with gentamycin-loaded chitosan microspheres for infected bone defect treatment

Contact Info

Product

Resources

About