Vascularized Iliac Bone Graft in Cases of Ankle Tuberculosis

Yoshida, Tatsuya; Sakamoto, Akio; Iwamoto, Yukihide

doi:10.1055/s-0028-1103501

Cited by 5 publications

(2 citation statements)

References 17 publications

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“…Unique to TB or any other infective pathology is the need for local rotation/ microvascular flap with bone grafting, when significant amount of necrotic skin and soft tissue around the ankle joint has to be excised to achieve a healthy environment for subsequent arthrodesis [26]. The flap provides a thick vascular soft tissue cover for the bone graft and reduces incidence on non-union.…”

Section: Reconstructive Procedures For Anklementioning

confidence: 99%

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Role of Surgery in Management of Osteo-Articular Tuberculosis of the Foot and Ankle

Dhillon¹,

Agashe²,

Patil³

2017

TOORTHJ

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Background:Tuberculosis of the foot and ankle still remains to be a significant problem, especially in the developing countries, and with an increase in incidence in immunosuppressed patients. Treatment is mainly medical using multidrug chemotherapy; surgical interventions range from biopsy, synovectomy and debridement, to joint preserving procedures like distraction in early cases, and arthrodesis of hindfoot joints and the ankle in advanced disease with joint destruction.Surgical Options: All procedures should be done after initiating appropriate medical management. The ankle is the commonest joint needing intervention, followed by the subtalar and talo-navicular joint. Forefoot TB limited to the bone rarely needs surgical intervention except when the infective focus is threatening to invade a joint. Articular disease can spread rapidly, so early diagnosis and treatment can influence the outcome. Surgical interventions may need to be modified in the presence of sinuses and active disease; fusions need compression, and implants have to be chosen wisely. External fixators are the commonest devices used for compression in active disease, but intramedullary nails better stabilize pantalar arthrodesis. Arthroscopy has become a valuable tool for visualizing the ankle and hindfoot joints, and is an excellent adjunct for arthrodesis by minimally invasive methods.Conclusion:Although Osteoarticular Tb involving the foot and ankle is largely managed with chemotherapy, specific indications for surgical intervention exist. Timely done procedures could limit joint destruction, or prevent spread to adjacent joints. Fusions are the commonest procedure for sequelae of disease or for correcting residual deformity.

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Section: Reconstructive Procedures For Anklementioning

confidence: 99%

“…Yoshida and co-authors [26] treated one middle aged and one elderly patient with debridement and arthrodesis. Both of these had been misdiagnosed either as septic arthritis or as PVNS.…”

Section: Reconstructive Procedures For Anklementioning

confidence: 99%

Role of Surgery in Management of Osteo-Articular Tuberculosis of the Foot and Ankle

Dhillon¹,

Agashe²,

Patil³

2017

TOORTHJ

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Ankle arthrodesis in tubercular arthritis using anterior bridge plating: A report of 2 cases

Jain

Singh

2014

The Foot

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Restoration of Spinopelvic Continuity with the Free Fibula Flap after Limb-Sparing Oncologic Resection Is Associated with a High Union Rate and Superior Functional Outcomes

Mericli

Boukovalas

Roubaud

et al. 2020

Plastic &Amp; Reconstructive Surgery

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Background: Type 1 internal hemipelvectomies and total sacrectomies cause significant biomechanical instability, demanding pelvic ring reconstruction for ambulation and torso support. Previously described methods include autografts, allografts, and implants, commonly with poor long-term outcomes. The authors hypothesized that the free fibula flap for spinopelvic reconstruction is safe and effective, and associated with a high bony union rate and superior functional outcomes. Methods: The authors performed a retrospective review of all patients who underwent free fibula flap surgery after internal hemipelvectomy or total sacrectomy at M. D. Anderson Cancer Center from 2003 to 2018. The primary outcome was radiographic evidence of bony union. Secondary outcomes included surgical-site occurrence and lower extremity function. Univariate and multivariate logistic regression analyses were performed. Results: Forty-seven patients were included (internal hemipelvectomy, n = 38; total sacrectomy, n = 9). The mean follow-up was 3.3 years and the most common abnormality was chondrosarcoma (30.4 percent). The nonunion rate was 9.7 percent and the surgical-site occurrence rate was 34 percent; there were no flap losses. Greater age was significantly associated with nonunion (OR, 1.1; 95 percent CI, 1 to 1.2; p = 0.003), whereas obesity was the only independent predictor of surgical-site occurrence (OR, 9.2; 95 percent CI, 1.2 to 71.3; p = 0.03). Functional metrics approached those of adult norms by 3 years postoperatively. Compared to internal hemipelvectomy patients, patients undergoing total sacrectomy had more comorbidities, a higher complication rate, and a worse functional outcome. Conclusion: The free fibula flap for spinopelvic reconstruction is safe and effective, and is associated with a high bony union rate and superior functional outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

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Vascularized Iliac Bone Graft in Cases of Ankle Tuberculosis

Cited by 5 publications

References 17 publications

Role of Surgery in Management of Osteo-Articular Tuberculosis of the Foot and Ankle

Role of Surgery in Management of Osteo-Articular Tuberculosis of the Foot and Ankle

Ankle arthrodesis in tubercular arthritis using anterior bridge plating: A report of 2 cases

Restoration of Spinopelvic Continuity with the Free Fibula Flap after Limb-Sparing Oncologic Resection Is Associated with a High Union Rate and Superior Functional Outcomes

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