Bone infections often manifest with soft tissue complications such as severe scarring, fistulas, or ulcerations. Ideally, their management involves thorough debridement of infected bone and associated soft tissues, along with achieving stable bone structure, substantial tissue coverage, and long-term antibiotic therapy. The formation of a multidisciplinary team comprising orthopedic surgeons, plastic surgeons, and infectious disease specialists is essential in addressing the most complex cases. We conducted a retrospective study during six years (2018-2023) at our university center. Focusing on the most challenging cases, we included patients with bone infections in the leg and/or foot requiring free flap reconstruction. Each patient underwent simultaneous bone debridement and reconstruction by the orthopedic team, alongside soft tissue debridement and free flap reconstruction by the plastic surgery team. Targeted antibiotic therapy for either 6 weeks (acute) or 12 weeks (chronic osteitis) was initiated based on intraoperative cultures. Additional procedures such as allografts, arthrodesis, or autografts were performed if necessary. We analyzed the rates of bone union, infection resolution, and limb preservation.Aim
Method
The main weakness of the classical external þxator is the penetration of the bone, this conducting to the entrance of the pathogenic germs by their migration toward the pins. Despite the fact that the centromedullary synthesis is done after several weeks after the removal of the external þxator the risk of infection after the operation remains signiþcantly high. Considering these theoretical assumptions and experiencing in our current practice such complications we have started to use 3 years ago the pinless external þxator for the stabilization of the tibia fractures. Between 1999–2002 there were hospitalized and operated 213 patients with open tibia fractures, 28 being treated using the pinless external þxator. From those cases PEF was used for 9 patients with type II lesions, 8 patients with type IIIA lesions and 3 patients with type IIIB lesions. After resolving the soft tissue injuries (approx. 2 weeks) the external stabilization was converted to internal centromedullar solid stabilization, without the risks associated with the use of the classical external þxator. Our conclusion was that the external pinless þxator is less invasive, stable and realize a good adherence to the bone. This guarantees the centromedullary conversion of the osteosynthesis with minimal risks, as it doesnñt expose the medullar cavity of the shaft.
