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Combined Orthoplastic Approach in Fracture-Related Infections of the Distal Tibia

This series reports on the treatment of distal tibia (DT) fracture-related infections (FRI) with a combined orthoplastic approach. Thirteen patients were included. In eight patients with extensive bone involvement and in those with a non-healed fracture, the DT was resected (“staged approach”). In f...

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Autores principales: Sambri, Andrea, Pignatti, Marco, Tedeschi, Sara, Lozano Miralles, Maria Elisa, Giannini, Claudio, Fiore, Michele, Filippini, Matteo, Cipriani, Riccardo, Viale, Pierluigi, De Paolis, Massimiliano
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9414956/
https://www.ncbi.nlm.nih.gov/pubmed/36014058
http://dx.doi.org/10.3390/microorganisms10081640
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author Sambri, Andrea
Pignatti, Marco
Tedeschi, Sara
Lozano Miralles, Maria Elisa
Giannini, Claudio
Fiore, Michele
Filippini, Matteo
Cipriani, Riccardo
Viale, Pierluigi
De Paolis, Massimiliano
author_facet Sambri, Andrea
Pignatti, Marco
Tedeschi, Sara
Lozano Miralles, Maria Elisa
Giannini, Claudio
Fiore, Michele
Filippini, Matteo
Cipriani, Riccardo
Viale, Pierluigi
De Paolis, Massimiliano
author_sort Sambri, Andrea
collection PubMed
description This series reports on the treatment of distal tibia (DT) fracture-related infections (FRI) with a combined orthoplastic approach. Thirteen patients were included. In eight patients with extensive bone involvement and in those with a non-healed fracture, the DT was resected (“staged approach”). In five cases, the DT was preserved (“single-stage approach”). A wide debridement was performed, and the cavity was filled with antibiotic-loaded PerOssal beads. All patients had a soft-tissue defect covered by a free vascularized flap (anterolateral thigh perforator flap in eight cases, latissimus dorsi flap in five). At the final follow-up (mean 25 months, range, 13–37), no infection recurrence was observed. In one patient, the persistence of infection was observed, and the patient underwent a repeated debridement. In two cases, a voluminous hematoma was observed. However, none of these complications impacted the final outcome. The successful treatment of FRI depends on proper debridement and obliteration of dead spaces with a flap. Therefore, when dealing with DT FRI, debridement of infected bone and soft tissues must be as radical as required, with no fear of the need for massive reconstructions.
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spelling pubmed-94149562022-08-27 Combined Orthoplastic Approach in Fracture-Related Infections of the Distal Tibia Sambri, Andrea Pignatti, Marco Tedeschi, Sara Lozano Miralles, Maria Elisa Giannini, Claudio Fiore, Michele Filippini, Matteo Cipriani, Riccardo Viale, Pierluigi De Paolis, Massimiliano Microorganisms Article This series reports on the treatment of distal tibia (DT) fracture-related infections (FRI) with a combined orthoplastic approach. Thirteen patients were included. In eight patients with extensive bone involvement and in those with a non-healed fracture, the DT was resected (“staged approach”). In five cases, the DT was preserved (“single-stage approach”). A wide debridement was performed, and the cavity was filled with antibiotic-loaded PerOssal beads. All patients had a soft-tissue defect covered by a free vascularized flap (anterolateral thigh perforator flap in eight cases, latissimus dorsi flap in five). At the final follow-up (mean 25 months, range, 13–37), no infection recurrence was observed. In one patient, the persistence of infection was observed, and the patient underwent a repeated debridement. In two cases, a voluminous hematoma was observed. However, none of these complications impacted the final outcome. The successful treatment of FRI depends on proper debridement and obliteration of dead spaces with a flap. Therefore, when dealing with DT FRI, debridement of infected bone and soft tissues must be as radical as required, with no fear of the need for massive reconstructions. MDPI 2022-08-12 /pmc/articles/PMC9414956/ /pubmed/36014058 http://dx.doi.org/10.3390/microorganisms10081640 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Sambri, Andrea
Pignatti, Marco
Tedeschi, Sara
Lozano Miralles, Maria Elisa
Giannini, Claudio
Fiore, Michele
Filippini, Matteo
Cipriani, Riccardo
Viale, Pierluigi
De Paolis, Massimiliano
Combined Orthoplastic Approach in Fracture-Related Infections of the Distal Tibia
title Combined Orthoplastic Approach in Fracture-Related Infections of the Distal Tibia
title_full Combined Orthoplastic Approach in Fracture-Related Infections of the Distal Tibia
title_fullStr Combined Orthoplastic Approach in Fracture-Related Infections of the Distal Tibia
title_full_unstemmed Combined Orthoplastic Approach in Fracture-Related Infections of the Distal Tibia
title_short Combined Orthoplastic Approach in Fracture-Related Infections of the Distal Tibia
title_sort combined orthoplastic approach in fracture-related infections of the distal tibia
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9414956/
https://www.ncbi.nlm.nih.gov/pubmed/36014058
http://dx.doi.org/10.3390/microorganisms10081640
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