From the Plastic Surgery and Burns Unit, Centre FX Michelet, Bordeaux University Hospital; Surgery School, University of Bordeaux; Department of Anesthesiology and Critical Care, Bordeaux University Hospital; Department of Infectious and Tropical Diseases and South-Western France Referral Center for Complex Bone and Joint Infections (Crioac GSO), Bordeaux University Hospital; Department of Orthopedic Surgery, Bordeaux University Hospital; and Department of Thoracic Surgery, Bordeaux University Hospital.
Plast Reconstr Surg. 2021 Aug 1;148(2):443-453. doi: 10.1097/PRS.0000000000008175.
Treating chronic osteomyelitis of the lower extremities is challenging. The treatment of acute lower limb trauma by orthoplastic teams has shown good results over the past few decades. This study aimed to characterize surgical outcomes of leg and heel chronic osteomyelitis by an orthoplastic team.
The cases of 113 consecutive leg and heel chronic osteomyelitis patients undergoing soft-tissue reconstruction with an orthopedic procedure were reviewed in this retrospective single-center observational study. The main objective was to assess surgical outcomes of skin healing and gait recovery at the 1-year follow-up. The secondary objective was to evaluate the global success rate at the last follow-up.
The median follow-up was 19.7 months. A free flap was performed for 33 patients (29.2 percent) and a locoregional flap was used in 79 patients (69.9 percent). Seventy-two patients (63.7 percent) had chronic osteomyelitis on continuous bone. The others had a septic pseudarthrosis with a mean bone defect length of 42.9 mm. Forty-four patients (38.9 percent) underwent curettage only, eight (7.1 percent) underwent curettage and cement, 20 (17.7 percent) underwent curettage and bone fixation, and 39 (34.5 percent) underwent the Masquelet technique. At the 1-year follow-up, 72 patients (63.7 percent) had achieved skin healing and had recovered their gait. The success rate at all follow-up time points was 82.3 percent. The median time to achieve skin healing was 6.5 months and that to bone union in cases of septic pseudarthrosis was 7.9 months.
Orthoplastic management of leg and heel chronic osteomyelitis patients with combined soft-tissue reconstruction using an orthopedic procedure was a viable strategy that offered good results even though the time to complete healing was long.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
治疗下肢慢性骨髓炎具有挑战性。几十年来，矫形团队治疗急性下肢创伤已取得良好效果。本研究旨在通过矫形团队描述腿部和足跟慢性骨髓炎的手术结果。
本回顾性单中心观察性研究纳入了 113 例连续的腿部和足跟慢性骨髓炎患者，这些患者接受了矫形手术中的软组织重建。主要目的是评估 1 年随访时皮肤愈合和步态恢复的手术结果。次要目的是评估最后随访时的总体成功率。
中位随访时间为 19.7 个月。33 例患者（29.2%）接受游离皮瓣，79 例患者（69.9%）接受局部皮瓣。72 例患者（63.7%）慢性骨髓炎连续累及骨骼，其余患者存在感染性假关节，平均骨缺损长度为 42.9mm。44 例患者（38.9%）仅行清创术，8 例患者（7.1%）行清创术和骨水泥填充，20 例患者（17.7%）行清创术和骨固定，39 例患者（34.5%）行 Masquelet 技术。1 年随访时，72 例患者（63.7%）皮肤愈合，步态恢复。所有随访时间点的成功率为 82.3%。皮肤愈合的中位时间为 6.5 个月，感染性假关节的骨愈合时间为 7.9 个月。
采用矫形手术联合软组织重建的方法治疗腿部和足跟慢性骨髓炎患者是一种可行的策略，即使完全愈合时间较长，但结果良好。
临床问题/证据水平：风险，III。
