Hyperbaric oxygen as adjunctive therapy for osteomyelitis.

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Abstract

[Indexed for MEDLINE] 14. Acta Orthop. 2020 Jun;91(3):353-359. doi: 10.1080/17453674.2020.1745423. Epub 2020 Apr 2. Single-stage debridement with implantation of antibiotic-loaded calcium sulphate in 34 cases of localized calcaneal osteomyelitis. Jiang N(1)(2), Zhao XQ(2), Wang L(1), Lin QR(1), Hu YJ(1), Yu B(1)(2). Author information: (1)Department of Orthopaedics & Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou. (2)Guangdong Provincial Key Laboratory of Bone & Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, P R China. Background and purpose - The successful eradication of calcaneus infection with limb salvage remains a challenge. We describe the outcomes of cortical bone windowing followed by eggshell-like debridement and implantation of antibiotic-loaded calcium sulphate (CS) for localized (Cierny-Mader type III) calcaneal osteomyelitis (CO).Patients and methods - We report a retrospective study of 34 patients. Infection followed trauma or orthopedic surgery in 30 patients and hematogenous spread in 4 patients. 31 patients had a sinus tract, accompanied by a soft tissue defect in 3 patients. All patients received cortical bone windowing, debridement, multiple sampling, local implantation of vancomycin- and gentamicin-loaded CS, skin closure or flap coverage, and culture-specific systematic antibiotic treatment in a single-stage procedure. Patients were followed up for a median of 26 months.Results - Infection was eradicated in 29 patients after the single-stage surgery, and all of the 5 recurrent infections were cleared by repeated surgery without amputation. Other adverse events included 11 patients with aseptic wound leakage and 1 unrelated death. Compared with those before surgery, the median postoperative scores of the American Orthopaedic Foot & Ankle Society (AOFAS) ankle hindfoot scale (65 vs. 86 vs. 89) and the visual analog scale (VAS) for pain (6 vs. 3 vs. 1) improved at the 1-year and 2-year follow-up.Interpretation - This single-stage protocol, cortical bone windowing, and eggshell-like debridement combined with local implantation of antibiotic-loaded CS is effective in treating type III CO. However, the incidence of aseptic wound leakage is high. DOI: 10.1080/17453674.2020.1745423 PMCID: PMC8023923