Introduction: The aim of the present study was to evaluate the efficacy of the vacuum–assisted closure (V.A.C.) therapy in the treatment of early hip joint infections.

Patients and Methods: 28 patients (11 m/17 f; mean age 71 y. [43–84]) with early hip joint infections have been treated by means of the V.A.C.–therapy. At least one surgical procedure [1–7] has been unsuccessfully performed for infection treatment prior to V.A.C. – application. Pathogen organisms could have been isolated in 22/28 wounds. During revision, cup inlay and prosthesis head have been exchanged and 1–3 polyvinylalcohol sponges inserted into the wound cavity/periprosthetically at an initial continuous pressure of 200 mm Hg. Postoperatively, a systemic antibiosis was given according to antibiogram.

Results: 48–72 h after surgery an alteration from haemorrhagic to serous fluid was observed in the V.A.C.-canister. Afterwards, the pressure was decreased to 150 mm Hg and remained at this level till sponge removal. After a mean period of 9 [3–16] days the inflammation parameters have been retrogressive and the sponges were removed. An infection eradication could be achieved in 26/28 cases. In the two remaining cases the infected prosthesis had to be explanted and a gentamicin-vancomycin-loaded spacer has been implanted, respectively. At a total mean follow-up of 36 [12–87] months no reinfection or infection persistence was observed.

Discussion: The V.A.C.-system can be a valuable contribution in the treatment of early joint infections when properly used. Indications should be early infections with well-maintained soft-tissues for retention of the vacuum.

Introduction: The anterior tibial tendon rupture is an infrequent injury in the lower extremity. For prevention of misdiagnosis and further planing of surgical reconstruction exact knowledge of the foot anatomy and the tendon’s course are required.

Materials and Methods: We examined 27 formaldehyde-fixed cadavers (13 female-14 male) with a total of 53 feet (27 right, 26 left). 1 left leg was amputated. The skin and overlying fascia were removed to expose the anterior tibial muscle and tendon. The tendon was prepared along its entire course beneath the superior extensor retinaculum, special care was paid on osseous or tendinous abnormalities along its insertion into Os cuneiform mediale and Os metatarsal I. Photographs were then taken to document the pattern.

Results: 3 different insertion sites were noticed: in 36 feet the tendon inserted into the medial side of the cuneiform and the base of the first metatarsal bone and in 13 cases only into the medial side of the cuneiform bone. In the remaining 4 feet the tendon inserted into the cuneiform and the first metatarsal bone, but an additional tendon was noted taking its origin from the tibialis ant. tendon near its insertion into the os cuneiforme mediale and attaching to the proximal part of the metatarsal I.

Discussion: Knowledge of the anatomy in this region may be helpful primarily for diagnosis and subsequently for the interpretation of intraoperative findings and making the right choice for the most appropriate surgical procedure.