In summary, I believe that when faced with a definitely diagnosed deep infection involving a joint replacement of the foot, the treatment of choice is incision and drainage of the wound with removal of the implant and all necrotic bone and soft tissue. Postoperatively, some form of drainage-promoting system should be instituted. Three techniques for promoting drainage have been discussed: open packing, which technically is the easiest to accomplish, but necessitates either delayed primary closure, healing by secondary intention, or in some cases skin grafting; this obviously increases disability time; standard closed suction irrigation, which has the advantage of primary wound closure but the disadvantage of requiring around-the-clock supervision to ensure against blockage of fluid flow, especially through the egress tube; and the Sorto modification of the one-tube in-out drainage system, which has the same advantage as closed suction irrigation (primary wound closure) without the risk of blockage of the egress tube. The key to successful management of an infected implant is immediate and aggressive treatment once a definitive diagnosis is made. Although the systemic use of antibiotics is an important adjunct in the total treatment plan, one must think in terms of altering the local environment in which the offending organisms grow and multiply. This is best accomplished by decompressing the infected wound by incision and drainage; removing all necrotic tissue or foreign bodies (that is, implants); and continuously promoting drainage postoperatively. Parenteral antibodies are only effective if the blood system through which they travel reaches the local site of infection. This cannot readily occur in the presence of increased soft-tissue tension created by an infectious process. In the words of Louis Pasteur, when dealing with an infection, "The bacteria is nothing, it is the environment in which it grows that is everything."
总之，我认为当面对明确诊断的涉及足部关节置换的深部感染时，首选的治疗方法是切开伤口引流，取出植入物以及所有坏死的骨组织和软组织。术后，应建立某种形式的促进引流系统。已讨论了三种促进引流的技术：开放填塞，从技术上讲这是最容易完成的，但需要延迟一期缝合、二期愈合，或者在某些情况下进行植皮；这显然会增加残疾时间；标准的闭式负压冲洗，其优点是伤口一期闭合，但缺点是需要全天候监护以确保防止液体流动受阻，尤其是通过引流管流出的液体；以及单管进出引流系统的索托改良法，它具有与闭式负压冲洗相同的优点（伤口一期闭合），且没有引流管堵塞的风险。成功处理感染植入物的关键是一旦做出明确诊断，立即进行积极治疗。尽管全身性使用抗生素是整个治疗计划中的重要辅助手段，但必须考虑改变有害微生物生长和繁殖的局部环境。这最好通过切开引流对感染伤口进行减压、清除所有坏死组织或异物（即植入物）以及术后持续促进引流来实现。只有当它们所通过的血液系统到达感染局部部位时，肠外抗体才有效。在感染过程导致软组织张力增加的情况下，这种情况不容易发生。用路易斯·巴斯德的话说，在处理感染时，“细菌并不重要，重要的是它生长的环境”。
