THERAPY OF CHRONIC TIBIA OSTEOMYELITIS BY USING TEMPORARY ANTIBIOTIC SPACER, ROTATORY MUSCLE LOBE, LARVAL THERAPY AND SPONGIOPLASTY WITH PEROSSAL- CASE REPORT
Authors:
Eva Čurlejová 1; Miroslav Homza 1; Igor Čižmář 1; Pavel Dráč 1; Milan Kamínek 2
Authors place of work:
Traumatologické oddělení FN Olomouc
Department of Trauma surgery, Faculty Hospital Olomouc
1; Klinika nukleární medicíny FN Olomouc
Department of Nuclear medicine, Faculty Hospital Olomouc
2
Published in the journal:
Úraz chir. 22., 2014, č.1
Category:
Case report
Summary
PURPOSE:
The aim of this work was to introduce diagnostic and surgical process in therapy of chronic tibia osteomyelitis.
MATERIAL AND METHODS:
The authors describe diagnostic and surgical intervention in 55 years old patient with chronic tibia osteomyelitis after plate ostheosynthesis. In setting of the diagnosis they used 18 F- fluorodeoxyglucose PET/ CT and SPECT / CT with marked leukocytes Le-Tc-HMPAO. In therapy they performed radical surgical debridement, lavage and they applied antibiotic spacer in whole medullar cavity of damaged bone. After that they applied the spongioplasty with hydroxyapatite bone replacement PerOssal. Defects of the soft tissues were primary closed by V.A.C. Subsequently they were covered with rotatory muscle lobe. The necrectomy was performed by using larvae Lucillia sericata/green.
RESULTS:
Patient is now without any problems 19 months after the procedure, without any signs of recurrent infection. Patient is able to burden fully his limb and the range of motion (ROM) in knee joint is without any restrictions.
CONCLUSION:
Described surgical procedure represetns one of the therapeutic possibilites of chronic osteomyelitis.
KEY WORDS:
Antibiotic-loaded bone substitute, chronic osteomyelitis, larval therapy, muscle flap, tibia.
Zdroje
1. AKTEKIN , C.M., OZTURK, A.M., TABAK, A.Y. et al. A different perspective for radiological evaluation of experimental osteomyelitis. Skeletal radiol. 2007, 36, 945–950.
2. BAER, W. S. The treatment of chronic osteomyelitis with the Maggot (Larva of the Blow Fly). Clin Orthop Relat Res. 2011, 469, 920–944.
3. BOWLER,P.G., DUERDEN, B.I., ARMSTRONG, D.G. Wound mikrobiology and associated approaches to wound management. Clin Microbiol Rev. 2001, 14, 244-269.
4. CLIMIC, A. Disease of skeletal muscle. In: Kissane, J., editor. Andersons pathology. Vol 2: Mosby. 1985, 1763–1764.
5. FORSBERG, J.A., POTTER, B.K., CIERNY III, G., WEBB, L. Diagnosis and management of chronic infection. J Am Acad Orthop Surg. 2011, 19, 8–19.
6. GOTTHARDT, M., BLEEKER-ROVERS, CH. P., BOERMAN, O. C., OYEN, W. J. G. Imaging of inflamation by PET, conventional scintigraphy, and other imaging techniques. The journal of nuclear medicine. 2010, 51, 1937–1949.
7. GUSTILO, R.B., ANDERSON, J.T. Prevention of infection in the management of one thousand and twenty-five open fractures of long bones. J Bone Joint Surg. 1976, 4, 453–458.
8. HARTMANN, A., EID, K., DORA, C. et al. Diagnostic value of 18F-FDG PET/CT in trauma patiens with suspected chronic osteomyelitis. Eur J Nucl Med Mol Imaging. 2007, 34, 704–714.
9. LABLER, L., KEEL, M., TRENTZ, O. Vacuum-Assisted Closure (V.A.C.) for temporary coverage of soft-tissue injury in type III open fracture of lower extremities. Eur J Trauma. 2004, 30, 305–312.
10. RAO, N., ZIRAN, B. H., LIPSKY, B. A. Treating osteomyelitis: Antibiotics and surgery. Plast Reconstr Surg. 2011, 127, 177–187.
11. TERMAAT, M.F., RAIJMAKERS, P.G.H.M., SCHOLTEN, H.J. The accuracy of diagnostic paging for the assessment of chronic osteomyelitis: A systematic review and Meta-analysis. J Bone Joint Surg Am. 2005, 87, 2464–2471.
12. UÇKAY, I., JUGUN, K., GAMULIN, A. et al. Chronic osteomyelitis. Curr Infect Dis Rep. 2012, 14, 566–575.
13. WALTER, G., KEMMERER, M., KAPPLER, C., HOFFMANN, R. Treatment algorithms for chronic osteomyelitis. Dtsch Arztebl Int. 2012, 109, 257–264.
Štítky
Surgery Traumatology Trauma surgeryČlánok vyšiel v časopise
Trauma Surgery
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