scholarly journals Debridement Technique and Dead Space Management For Infected Non-Union of the Tibia

2019 ◽  
Vol 2 (1) ◽  
pp. 29-36 ◽  
Author(s):  
Mahmoud El-Rosasy ◽  
Ashraf Mahmoud ◽  
Osama El-Gebaly ◽  
Ahmed Lashin ◽  
Edgardo Rodriguez-Collazo
Keyword(s):  
Dead Space ◽  
Space Management ◽  
Non Union

Die septische Pseudarthrose

2017 ◽  
Vol 26 (04) ◽  
pp. 229-235
Author(s):  
W. Böcker ◽  
V. Herterich ◽  
C. Zeckey
Keyword(s):  
Dead Space ◽  
Space Management

ZusammenfassungDie septische Pseudarthrose stellt weiterhin ein hochgradiges Problem in der muskulo -skelettalen Chirurgie dar. Das Zusammenspiel zwischen komplexen Behandlungsstrategien und dem entsprechend hohen Interventions-portfolio einerseits, andererseits aber ebenso durch die wechselnde und unterschiedliche Virulenz der Erreger sowie der variablen Immunkompetenz der betroffenen Patienten verkomplizieren die Situation erheblich. Neben den erheblichen medizinischen Problemen resultieren ebenso sozioökonomische Einschränkungen für die Betroffenen, was die Situation weiter verschärft. Unzureichende chirurgische Strategien resultieren in insuffizienten Ergebnissen mit Rezidiven oder Amputationen, die leider trotz ausführlichster Planung und chirurgischer Radikalität nie ganz ausgeschlossen werden können. Das prinzipielle Vorgehen bei septischen Pseudarthrosen besteht nach Diagnosestellung in der Resektion des in fizierten Knochenareals, der Isolation der entsprechenden Keime, der entsprechenden Antibiotikatherapie sowie aus anschließend folgenden rekonstruktiven Eingriffen nach Infektberuhigung. Kritisch ist hierbei das ,,dead-space“-Management nach ossärer Rekonstruktion durch Defektauffüllung unter Nutzung von Knochenzementen. Hier stehen verschiedene Optionen wie z. B. das Masquelet-Verfahren oder der Segmenttransport zur Verfügung. Der vorliegende Artikel soll Informationen über die Inzidenz der septischen Pseudarthrose, das typischerweise vorliegende Keimspektrum, die verfügbaren chirurgischen Behandlungsstrategien und einen Überblick über die aktuelle Literatur geben.

scholarly journals Development of a Novel Model for the Assessment of Dead-Space Management in Soft Tissue

PLoS ONE ◽  
2015 ◽  
Vol 10 (8) ◽  
pp. e0136514 ◽  
Author(s):  
Rema A. Oliver ◽  
Vedran Lovric ◽  
Yan Yu ◽  
Chris Christou ◽  
Sean S. Aiken ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Dead Space ◽  
Space Management ◽  
Novel Model

scholarly journals Local Delivery of Antibiotics in the Context of Chronic Diabetic Foot Infection with Bony Involvement: A Case Series of 102 Patients

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0044
Author(s):  
James Widnall ◽  
David Harvey ◽  
Paul Evans ◽  
Gillian Jackson ◽  
Simon Platt
Keyword(s):  
Dead Space ◽  
Salvage Surgery ◽  
Case Series ◽  
Calcium Sulphate ◽  
Surgical Debridement ◽  
P Value ◽  
Space Management ◽  
Bony Involvement ◽  
Local Antibiotic ◽  
Antibiotic Delivery

Category: Diabetes Introduction/Purpose: Diabetic foot infection (DFI) is a devastating condition which poses risk to both life and limb. Treatment principles revolve around surgical debridement, dead space management, delivery of both local and systemic antibiotics and soft tissue cover. Dead space management and local antibiotic delivery can be achieved simultaneously by using an antibiotic loaded bone substitute. We report our retrospective case series of patients treated with surgical management involving local antibiotic delivery via calcium sulphate bone substitute (Stimulan™; Biocomposites, Keele, UK). Methods: All patients between January 2015 and June 2018 with DFI and proven bony involvement presenting to our university teaching hospital were treated via our extensive MDT approach. A total of 102 patients were included. Surgical debridement was performed along with simultaneous insertion of 10 ml calcium sulphate with 1 g vancomycin and 240 mg gentamycin. Outcome was classified as resolved, requiring prolonged treatment from other medical (endocrinologist) or surgical (plastic surgery, limb reconstruction) services or salvage surgery in the form of proximal amputation. Results: 45.1% of patients had a partial amputation at the index surgery. 52% had bony debridement and just 2.9% had soft tissue debridement in conjunction with calcium sulphate insertion. The surgical wound was primarily closed in 56.8% of patients. 7 patients had delayed wound closure and 36.2% of patients healed via secondary intention. 74 patients (72.5%) had resolution of their DFI with bony involvement following surgical intervention. 21 (20.6%) patients needed further treatment from allied specialties. 7 (6.9%) patients required salvage surgery in the form of a below knee amputation. There was no correlation between either closure type (2 p-value 0.75) or index surgery type and outcome (2 p-value 0.64). Conclusion: DFI is a difficult clinical scenario to treat effectively. An MDT approach is undoubtedly key to a good outcome. We believe that the use of calcium sulphate can be a useful adjunct at the time of surgical debridement to aid in both dead space management and allow local antibiotic delivery.

scholarly journals Negative pressure wound therapy in orthopaedic post operative infections: Role in implant retention and dead space management

2015 ◽  
Vol 4 (4) ◽  
pp. 257
Author(s):  
Amarnath Surath ◽  
NandaKishore Maddineni ◽  
SatyaKumar Koduru ◽  
Harshavardan Surath ◽  
Ananda RaoVenkata Dakshina Murthy ◽  
...  
Keyword(s):  
Dead Space ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Wound Therapy ◽  
Space Management ◽  
Implant Retention

Dead Space Management After Orthopaedic Trauma

2016 ◽  
Vol 30 (2) ◽  
pp. 64-70 ◽  
Author(s):  
Mark J. Gage ◽  
Richard S. Yoon ◽  
Robert J. Gaines ◽  
Robert P. Dunbar ◽  
Kenneth A. Egol ◽  
...  
Keyword(s):  
Dead Space ◽  
Orthopaedic Trauma ◽  
Space Management

scholarly journals A systematic review of the single-stage treatment of chronic osteomyelitis

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Bethan Pincher ◽  
Carl Fenton ◽  
Rathan Jeyapalan ◽  
Gavin Barlow ◽  
Hemant K. Sharma
Keyword(s):  
Systematic Review ◽  
Dead Space ◽  
Chronic Osteomyelitis ◽  
Data Extraction ◽  
Financial Burden ◽  
Single Stage ◽  
Management Technique ◽  
Space Management ◽  
Wide Range

Abstract Background Despite advances in surgery, the treatment of chronic osteomyelitis remains complex and is often associated with a significant financial burden to healthcare systems. The aim of this systematic review was to identify the different single-stage procedures that have been used to treat adult chronic osteomyelitis and to evaluate their effectiveness. Methods Ovid Medline and Embase databases were searched for articles on the treatment of chronic osteomyelitis over the last 20 years. A total of 3511 journal abstracts were screened by 3 independent reviewers. Following exclusion of paediatric subjects, animal models, non-bacterial osteomyelitis and patients undergoing multiple surgical procedures, we identified 13 studies reported in English with a minimum follow-up period of 12 months. Data extraction and quality assessment were performed for all studies. Non-recurrence was defined as resolution of pain without recurrence of sinuses or need for a second procedure to treat infection within the described follow-up period. Results A total of 505 patients with chronic osteomyelitis underwent attempted single-stage procedures. Following debridement, a range of techniques have been described to eliminate residual dead space including biologic and non-biologic approaches. These include musculocutaneous flaps, insertion of S53P4 glass beads or packing with antibiotic-loaded ceramic or calcium-sulphate pellets. The average follow-up ranged from 12 to 110 months. The most common organism isolated was Staphylococcus aureus (35.2%). Non-recurrence ranged from 0 to 100%. Debridement alone was statistically significantly inferior to approaches that included dead space management (54.5% versus 90% non-recurrence). Biologic and non-biologic approaches to dead space management were comparable (89.8% versus 94.2% non-recurrence). Conclusion A wide range of single-stage procedures have been performed for the treatment of chronic osteomyelitis. In general, studies were small and observational with various reporting deficiencies. No one dead space management technique appears to be superior, but debridement alone that leaves residual dead space should be avoided.

scholarly journals Evidence-Based Recommendations for Local Antimicrobial Strategies and Dead Space Management in Fracture-Related Infection

2020 ◽  
Vol 34 (1) ◽  
pp. 18-29 ◽  
Author(s):  
Willem-Jan Metsemakers ◽  
Austin T. Fragomen ◽  
T. Fintan Moriarty ◽  
Mario Morgenstern ◽  
Kenneth A. Egol ◽  
...  
Keyword(s):  
Dead Space ◽  
Evidence Based ◽  
Space Management

scholarly journals Fever in a patient with osteomyelitis: the diagnosis could be serotonin syndrome

2021 ◽  
Vol 14 (2) ◽  
pp. e239152
Author(s):  
Matthew Gould ◽  
William D Harrison ◽  
Abbey Cahill-Kearns ◽  
Greg Barton
Keyword(s):  
Staphylococcus Aureus ◽  
Serotonin Syndrome ◽  
Proximal Tibia ◽  
Multimodal Analgesia ◽  
Positive Outcome ◽  
Tibial Osteotomy ◽  
Space Management ◽  
Non Union ◽  
Important Message ◽  
Clinical Presentations

Awareness of rare differential diagnoses of common clinical presentations helps promote early detection and prompt management of serious conditions. A 54-year-old man, with an infected non-union following a high tibial osteotomy, presented with an acutely discharging abscess to his proximal tibia. He was generally unwell with a Staphylococcus aureus bacteraemia. The tibia was debrided, CERAMENT G used as dead space management and a spanning external fixator applied. Postoperatively, pregabalin and tapentadol were commenced in addition to amitriptyline and sertraline, which the patient was taking regularly. Overnight, the patient developed hyperthermia, inducible clonus, hyperreflexia, agitation, confusion and rigors. Prompt recognition of the possibility of serotonin syndrome resulted in early cessation of serotonergic medications and a positive outcome. From this case an important message is that fever in a patient taking serotonergic medications should prompt a screening neurological examination. Clinicians should also be wary when patients are commenced on multimodal analgesia, including tapentadol.

scholarly journals Application of Calcium Sulfate for Dead Space Management in Soft Tissue: Characterisation of a Novel In Vivo Response

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Rema A. Oliver ◽  
Vedran Lovric ◽  
Chris Christou ◽  
Sean S. Aiken ◽  
John J. Cooper ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Muscle Tissue ◽  
Dead Space ◽  
Calcium Sulfate ◽  
Rabbit Model ◽  
Fundamental Aspect ◽  
Surgical Removal ◽  
Space Management ◽  
Bone Void Filler

Management of dead space (DS) is a fundamental aspect of surgery. Residual DS following surgery can fill with hematoma and provide an environment for bacterial growth, increasing the incidence of postoperative infection. Materials for managing DS include polymethyl-methacrylate (PMMA), which is nonresorbing and requires removal in a second surgical procedure. The use of calcium sulfate (CS) offers the advantage of being fully absorbed and does not require subsequent surgical removal. As CS has historically been used as a bone void filler, there are some concerns for the risk of heterotopic ossification (HO) when implanted adjacent to soft tissue. This study assessed the osteoinductive potential of CS and identified and characterised residual material present in muscle tissue using histology, energy-dispersive X-ray spectroscopy analysis, and scanning electron microscopy (SEM). CS beads with and without antibiotic were implanted in intramuscular sites in both athymic rats and New Zealand white rabbits. At 28 days after implantation in the rat model, no signs of osteoinduction were observed. In the rabbit model, at 21 days after implantation, almost complete bead absorption and presence of a “halo” of material in the surrounding muscle tissue were confirmed. Our results suggested that the halo of material was a calcium phosphate precipitate, not HO.

scholarly journals The management of chronic osteomyelitis in adults: outcomes of an integrated approach

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Rudolph G Venter ◽  
Yashwant S Tanwar ◽  
Jan-Petrus Grey ◽  
Nando Ferreira
Keyword(s):  
South Africa ◽  
Bioactive Glass ◽  
Dead Space ◽  
Chronic Osteomyelitis ◽  
Integrated Approach ◽  
Appendicular Skeleton ◽  
Type I ◽  
Level Of Evidence ◽  
Space Management

ABSTRACT BACKGROUND: This study presents the outcomes of the management of chronic osteomyelitis of the appendicular skeleton according to an integrated approach at a dedicated bone infection unit in South Africa. METHODS: A retrospective record review identified 80 patients who were treated between January 2016 and December 2018. RESULTS: Sixty patients (75%) presented with fracture-related infections, 17 patients (21%) developed chronic osteomyelitis following haematogenous spread and three (4%) from contiguous wounds. According to the Cierny and Mader classification, 21 patients presented with anatomical type I, 14 with type II, 24 with type III and 21 with type IV chronic osteomyelitis. Positive microbial cultures were obtained in 63 (79%) cases. Follow-up for the cohort ranged from 1 to 29 months, with a mean follow-up of 10.4 months. The overall complication rate for the cohort was 6% and included sterile drainage from the surgical site after management with bioactive glass (S53P4), refracture after hardware removal, and development of non-union. Five patients experienced recurrence after the initial procedure to eradicate infection, resulting in an overall resolution rate of 94%. CONCLUSION: Using single-stage surgeries and tailored dead space management strategies according to a comprehensive integrated approach developed in South Africa, results comparable to international literature can be achieved. Level of evidence: Level 4. Keywords: chronic osteomyelitis, dead space management, bioactive glass, Lautenbach technique

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