Abstract
Purpose: Progress in medical and surgical management has reduced the incidence of osteitis. Nevertheless, this type of complication remains a difficult therapeutic challenge for frail polyoperted patients exposed to infection for several months. Based on a technique developed by A.C. Masquelet and cooperative work with the infectiology unit, we propose an alternative to eminent amputation.
Material and methods: The series included eighteen surgery patients (fifteen men and three women, mean age 37 years) Mean follow-up was fifteen months. Fourteen patients had undergone one or several operations. Bone loss varied from 5 to 17 cm with shaft loss in ten patients and metaphyseal loss in eight. Fifteen reconstructions involved the lower limb: three femurs, nine tibias and three tarsal bones. Three cases involved the upper limbs: elbow, radius, and radiocarpal bones, one each. Meti-R bacilli were identified in eleven patients. Reconstruction was based on the Masquelet spacer technique to induce membranes in all cases. External fixation was used in sixteen cases and pinning in two. A second operation was performed after normalisation of biological parameters and wound healing.
Results: There were no early complications. Late wound healing required a secondary flap in three patients. There was one graft failure after early reinfection. The spacer was in place for a mean four months. Healing was achieved at six months on the average. A second graft was required in two patients.
Discussion: This series demonstrates the usefulness of this bone reconstruction method irrespective of the soft tissue trophicity and the degree of bone loss. It allows maximal debridement of infected tissue, the only method allowing effective eradication of infection. The close cooperation with the infectiology unit was particularly helpful for the management of the more difficult cases allowing bone grafting beyond usual limits.
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