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Muscle flaps in the treatment of osteomyelitis of the lower extremity.

Abstract

Thirty three consecutive patients with chronic osteomyelitis and deficient soft tissue coverage treated with a muscle flap from 1991-1998 were reviewed retrospectively. Osteomyelitis was diagnosed by positive bone cultures and radiographic changes consistent with osteomyelitis. Osteomyelitis was divided into localized <50% diameter: 24 patients and diffuse >50% diameter or infected nonunion: 9 patients. The average age was 38 (18-74). The cause of the osteomyelitis was open fracture 23, closed fracture and open reduction internal fixation 5, gunshot wound 3, burn 1, and chronic venous stasis ulcer 1. Localized osteomyelitis was treated with saucerization and coverage with a free or rotational muscle flap. Pandiaphyseal osteomyelitis was treated with a complete diaphysectomy in 3, and wide saucerization in 2. Twenty three patients were treated with a free flap and 10 with a rotational flap.A reconstructive success was considered a limb that allowed full weight bearing with a stable wound, no drainage and no recurrence of infection. Patients were evaluated for risk factors: malnutrition, renal or liver failure, alcohol abuse, immune deficiency, chronic hypoxia, malignancy, diabetes, age over 70, steroid therapy, tobacco abuse, or drug abuse. Patients were followed an average of 34 months (12-58) after surgery. A reconstructive success was achieved in 91% (20/22) of patients with local osteomyelitis and in 56% (5/9) of patients with diffuse osteomyelitis (p < 0.05). A reconstructive success was achieved in 88% (7/8) patients with no risk factors and in 78% (18/23) of patients with one or more risk factors (not significant p = 0.05).

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Cook County Hospital, Division of Orthopedic Surgery, Chicago, Illinois 60612, USA.

    Source

    The Journal of trauma 58:5 2005 May pg 1019-23

    MeSH

    Adolescent
    Adult
    Aged
    Debridement
    Female
    Humans
    Lower Extremity
    Male
    Middle Aged
    Osteomyelitis
    Retrospective Studies
    Risk Factors
    Surgical Flaps
    Treatment Failure

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    15920418

    Citation

    Gonzalez, Mark H., and Norman Weinzweig. "Muscle Flaps in the Treatment of Osteomyelitis of the Lower Extremity." The Journal of Trauma, vol. 58, no. 5, 2005, pp. 1019-23.
    Gonzalez MH, Weinzweig N. Muscle flaps in the treatment of osteomyelitis of the lower extremity. J Trauma. 2005;58(5):1019-23.
    Gonzalez, M. H., & Weinzweig, N. (2005). Muscle flaps in the treatment of osteomyelitis of the lower extremity. The Journal of Trauma, 58(5), pp. 1019-23.
    Gonzalez MH, Weinzweig N. Muscle Flaps in the Treatment of Osteomyelitis of the Lower Extremity. J Trauma. 2005;58(5):1019-23. PubMed PMID: 15920418.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Muscle flaps in the treatment of osteomyelitis of the lower extremity. AU - Gonzalez,Mark H, AU - Weinzweig,Norman, PY - 2005/5/28/pubmed PY - 2005/6/29/medline PY - 2005/5/28/entrez SP - 1019 EP - 23 JF - The Journal of trauma JO - J Trauma VL - 58 IS - 5 N2 - Thirty three consecutive patients with chronic osteomyelitis and deficient soft tissue coverage treated with a muscle flap from 1991-1998 were reviewed retrospectively. Osteomyelitis was diagnosed by positive bone cultures and radiographic changes consistent with osteomyelitis. Osteomyelitis was divided into localized <50% diameter: 24 patients and diffuse >50% diameter or infected nonunion: 9 patients. The average age was 38 (18-74). The cause of the osteomyelitis was open fracture 23, closed fracture and open reduction internal fixation 5, gunshot wound 3, burn 1, and chronic venous stasis ulcer 1. Localized osteomyelitis was treated with saucerization and coverage with a free or rotational muscle flap. Pandiaphyseal osteomyelitis was treated with a complete diaphysectomy in 3, and wide saucerization in 2. Twenty three patients were treated with a free flap and 10 with a rotational flap.A reconstructive success was considered a limb that allowed full weight bearing with a stable wound, no drainage and no recurrence of infection. Patients were evaluated for risk factors: malnutrition, renal or liver failure, alcohol abuse, immune deficiency, chronic hypoxia, malignancy, diabetes, age over 70, steroid therapy, tobacco abuse, or drug abuse. Patients were followed an average of 34 months (12-58) after surgery. A reconstructive success was achieved in 91% (20/22) of patients with local osteomyelitis and in 56% (5/9) of patients with diffuse osteomyelitis (p < 0.05). A reconstructive success was achieved in 88% (7/8) patients with no risk factors and in 78% (18/23) of patients with one or more risk factors (not significant p = 0.05). SN - 0022-5282 UR - https://www.unboundmedicine.com/medline/citation/15920418/Muscle_flaps_in_the_treatment_of_osteomyelitis_of_the_lower_extremity L2 - http://Insights.ovid.com/pubmed?pmid=15920418 DB - PRIME DP - Unbound Medicine ER -