Abstract
Previous reports have shown the efficacy of muscle interposition grafts in treating recalcitrant infection in the presence of hip arthroplasty. We report our experience with a two stage debridement and rectus femoris pedicled interposition graft technique in chronic severe native hip infection with a persistent draining sinus.
During the last 16 months, three paraplegic patients presented with persistently draining sinuses and chronic osteomyelitis of the pelvis, acetabulum and proximal femur, in a total of four hips. The mean patient age was 49 years (range, 40 to 59 years). In all patients there had been previous attempts to control the infection with wound debridement and long-term antibiotics.
A two-stage operative treatment was used in all patients. The first stage comprised wound debridement, washout, gentamycin-bead application and temporary vacuum assisted wound coverage.
At the second stage, approximately ten days later, through a standard anterior midline incision, the rectus femoris muscle was elevated on its pedicle, rolled, transposed into the acetabulum and sutured to the transverse acetabular ligament. At the second stage, all patients had local administration of antibiotics with genetamycin impregnated absorbable collagen fleece and all wounds were closed by delayed primary closure with a negative pressure dressing placed over the closed wound. All patients were commenced on a 6 week course of intravenous antibiotics, according to sensitivities.
No loss of flap occurred in any of the patients. One wound had partial dehiscence and required a split skin graft. At the final follow-up examination all the wounds were healed and there was no recurrence of draining sinuses, pressure sores or systemic sepsis.
The two stage technique with a pedicled rectus femoris interposition graft may be a useful technique for the treatment of complex chronic persistent osteomyelitis of the pelvis, acetabulum and proximal femur, with the primary aim of stopping the discharging sinus.
