Surgical debridement in long bone chronic osteomyelitis: is wide tumour-like resection necessary?

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Abstract

Conflict of interest statement: G. Barlow reports participation on a data safety monitoring Board or advisory board for BioMerieux, which is unrelated to this work. Cher B. Chuo declares registration sponsorship for faculty presentations at the 42nd Société Internationale de Chirurgie Orthopédique et de Traumatologie (Orthopaedic World Congress), which is unrelated. H. Sharma discloses payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events for Biocomposites; and being in a leadership or fiduciary role in other board, society, committee or advocacy group for the British Limb Reconstruction Society, SICOT, the Journal of Limb Lengthening and Reconstruction, and the Journal of Orthopaedics. 12. Int J Low Extrem Wounds. 2023 Jun;22(2):393-400. doi: 10.1177/15347346211016696. Epub 2021 May 3. An Effective Technique for Managing the Calcaneus Osteomyelitis Combined with Soft-Tissue Defect. Peng P(1), Dong ZG(1), Liu L(1), Wei JW(1), Luo Z(1), Cao S(1). Author information: (1)The Second Xiangya Hospital, Central South University, Changsha, Hunan, China. The treatment of the Cierny-Mader (C-M) type III-IV calcaneus osteomyelitis combining with the soft-tissue defect is sophisticated and difficult. The aim of this study is to introduce the application and availability of the modified distally based sural flap with an adipofascial extension to reconstruct these defects. We retrospectively reviewed the data of 37 patients with C-M type III-IV calcaneus osteomyelitis accompanied with soft-tissue defect between December 2004 and December 2019. A modified distally based sural flap with an adipofascial extension was conducted to reconstruct the defect. The patient's demographics, duration of the diseases, etiology, reconstruction outcomes, infection control rate, recurrence rate, amputation rate, and follow-up data were collected to evaluate the effectiveness and reliability of the modification. The American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot scale was applied to assess the function of the ankle and hindfoot. Thirty-four flaps survived uneventfully, 1 flap displayed marginal necrosis and 2 flaps (5.41%) developed partial necrosis. Using this modified flap alone or combining with some simple salvage methods reconstructed all of the defects successfully. The calcaneus osteomyelitis was cured successfully, and no recurrences were observed during the follow-up period. The AOFAS ankle and hindfoot scores were excellent in 27 patients and good in 8 patients. The distally based sural flap with an adipofacial extension is a simple and effective technique to reconstruct the calcaneus osteomyelitis combined with soft-tissue defect in 1 stage. Applications of the adipofacial extension to obliterate the dead space and the well-vascularized skin island to cover the defect are the guarantee of achieving good ankle and foot functions. However, this technique is not appropriate for the patients with calcaneum less than half weight-bearing area. DOI: 10.1177/15347346211016696