Sistema de Salut de Catalunya
Institut Català de la Salut
[Corona PS, Vicente M] Servei de Cirurgia Ortopèdica i Traumatologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. Unitat de Cirurgia Sèptica i Reconstructiva, Servei de Cirurgia Ortopèdica i Traumatologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Grup de Recerca en Enginyeria Tissular Musculoesquelètica, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. [Carbonell-Rosell C] Servei de Cirurgia Ortopèdica i Traumatologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. Unitat de Cirurgia Sèptica i Reconstructiva, Servei de Cirurgia Ortopèdica i Traumatologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Serracanta J] Servei de Cirurgia Plàstica i Cremats, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. [Tetsworth K] Department of Orthopaedic Surgery, Royal Brisbane and Women’s Hospital, Brisbane, Australia. Orthopaedic Research Centre of Australia, Brisbane, Australia. [Glatt V] Orthopaedic Research Centre of Australia, Brisbane, Australia. Department of Orthopaedic Surgery, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
Vall d'Hebron Barcelona Hospital Campus
2023-01-26T09:15:03Z
2023-01-26T09:15:03Z
2022-12
Bone transport; Infected tibial injury; Limb salvage
Transporte óseo; Lesión tibial infectada; Rescate de miembros
Transport ossi; Lesió tibial infectada; Rescat de membres
Introduction Managing critical-sized tibial defects is one of the most complex challenges orthopedic surgeons face. This is even more problematic in the presence of infection and soft-tissue loss. The purpose of this study is to describe a comprehensive three-stage surgical protocol for the reconstruction of infected tibial injuries with combined bone defects and soft-tissue loss, and report the clinical outcomes. Materials and methods A retrospective study at a specialized limb reconstruction center identified all patients with infected tibial injuries with bone and soft-tissue loss from 2010 through 2018. Thirty-one patients were included. All cases were treated using a three-stage protocol: (1) infected limb damage control; (2) soft-tissue coverage with a vascularized or local flap; (3) definitive bone reconstruction using distraction osteogenesis principles with external fixation. Primary outcomes: limb salvage rate and infection eradication. Secondary outcomes: patient functional outcomes and satisfaction. Results Patients in this series of chronically infected tibias had been operated upon 3.4 times on average before starting our limb salvage protocol. The mean soft-tissue and bone defect sizes were 124 cm2 (6–600) and 5.4 cm (1–23), respectively. A free flap was performed in 67.7% (21/31) of the cases; bone transport was the selected bone-reconstructive option in 51.7% (15/31). Local flap failure rate was 30% (3/10), with 9.5% for free flaps (2/21). Limb salvage rate was 93.5% (29/31), with infection eradicated in all salvaged limbs. ASAMI bone score: 100% good/excellent. Mean VAS score was 1.0, and ASAMI functional score was good/excellent in 86% of cases. Return-to-work rate was 83%; 86% were “very satisfied” with the treatment outcome. Conclusion A three-stage surgical approach to treat chronically infected tibial injuries with combined bone and soft-tissue defects yields high rates of infection eradication and successful limb salvage, with favorable functional outcomes and patient satisfaction.
Open Access Funding provided by Universitat Autonoma de Barcelona.
Article
Published version
English
Tíbia - Cirurgia; Tibia - Fractures; Infeccions quirúrgiques; Cirurgia plàstica; DISEASES::Wounds and Injuries::Fractures, Bone::Tibial Fractures; Other subheadings::Other subheadings::Other subheadings::/surgery; DISEASES::Bacterial Infections and Mycoses::Infection::Wound Infection; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Surgical Procedures, Operative::Reconstructive Surgical Procedures; ENFERMEDADES::heridas y lesiones::fracturas óseas::fracturas de la tibia; Otros calificadores::Otros calificadores::Otros calificadores::/cirugía; ENFERMEDADES::infecciones bacterianas y micosis::infección::infección de heridas; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::intervenciones quirúrgicas::procedimientos quirúrgicos reparadores
Springer
Archives of Orthopaedic and Trauma Surgery;142
https://doi.org/10.1007/s00402-021-04299-9
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
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