Vacuum sealing drainage combined with external fixator in the treatment of post-traumatic osteomyelitis

doi:10.3969/j.issn.2095-4344.2014.44.021

Abstract

Abstract:

BACKGROUND: Posttraumatic osteomyelitis is bone infection after surgery of open fractures or other joint, which leads to more secretions in antrum or bone exposed wounds, long treatment cycle, delayed healing of fracture, even disunion. The key link in the treatment is complete debridement, adequate drainage, and the use of external fixators with low interference and far away from lesions.
OBJECTIVE: To observe the clinical efficacy of external fixator combined vacuum sealing drainage (VSD) in the treatment of post-traumatic osteomyelitis, and compared with conventional catheter drainage.
METHODS: Since June 2010 to June 2013, 21 patients of post-traumatic chronic osteomyelitis were included in this study and divided into VSD group (n=11) and conventional catheter drainage group (n=10). All patients in VSD groups underwent debridement and VSD was used to fill dead space, then the wounds were sutured. Cases appeared nonhealing fractures underwent external fixation, 10 cases using external fixators and 1 case retained original external fixator. All patients achieved the closed wounds at the second phase, 9 cases were directly sutured, and 2 cases received skin flap transplantation. Among them, 1 case received autologous bone graft at the third phase because of bone defects. In the conventional catheter drainage group, all patients underwent debridement and conventional catheter drainage to rinse the wounds after surgery, 3 cases failing to close the wounds changed to receive ordinary dressing and skin flap transplantation at the second phase. Cases appeared nonhealing fractures underwent external fixation. Local swelling, pain and fever were observed after treatment. The time of total hospitalization stay and fracture healing was recorded.
RESULTS AND CONCLUSION: The VSD group quickly controlled preoperative symptoms such as swelling and pain and fever than the conventional catheter group (P < 0.05). The length of hospital stay showed no significant difference between the two groups (P > 0.05). All patients were obtained through clinic service and followed up for 24-36 months. The healing time in the VSD group was shorter than that in conventional catheter group (P < 0.05). Until the end of follow-up, no patients in the VSD group appeared infection recurrence, and two cases in the conventional catheter group had recurrent infection. The results suggest that VSD combined with external fixator can repair post-traumatic chronic osteomyelitis due to rapid control of infection, easy care, shortened treatment time, and reduced rate of postoperative recurrence. In addition, external fixator can be used as the final fixation for post-traumatic chronic osteomyelitis.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: osteomyelitis, drainage, vacuum sealing drainage, fracture healing

CLC Number:

R318

Deng Liang, He Fei, Wu Xiao-hui, He Jian-ying, Dong Xie-ping. Vacuum sealing drainage combined with external fixator in the treatment of post-traumatic osteomyelitis[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(44): 7167-7171.

Figures/Tables 3

References

[1]汪银锋,阮洪江,范存义.慢性创伤后骨髓炎诊治进展[J].国际骨科学杂志,2008,29(2):100-102.
[2]Klein S, Hage JJ, Woerdeman LA. Donor-site necrosis following fibula free-flap transplantation: a report of three cases. Microsurgery.2005;25(7):538-542.
[3]Michael S. Timmers MD, Niels Graafland MD,et al. Negative pressure wound treatment with polyvinyl alcohol foam and polyhexanide antiseptic solution instillation in posttraumatic osteomyelitis. Wound Repair Regen. 2009;17(2):278-286.
[4]Michael J,Patzakis MD,Zalavras MD,et al.Chronic Posttraumatic Osteomyelitis and Infected Nonunion of the Tibia: Current Management Concepts. J Am Acad Orthop Surg. 2005;13(6):6417-6427.
[5]金林.慢性骨髓炎应用VSD冲洗和常规置管冲洗临床对比观察[C].全国门急诊护理学术交流会议、第14届全国骨科护理学术交流会议论文汇编,2012.
[6]Wei D,Wang Y,Yuan J,et al. One-stage operation for pelvis and acetabular fractures combined with Morel-Lavallee injury by internal fixation associated with vacuum sealing drainage. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2014;28(1): 38-42.
[7]Hell M, Neureiter J, Wojna A. Post-traumatic Pseudallescheria apiosperma osteomyelitis: positive outcome of a young immunocompetent male patient due to surgical intervention and voriconazole therapy. Mycoses. 2011;54: 43-47.
[8]Li RG, Yu B, Wang G, et al. Sequential therapy of vacuum sealing drainage and free-flap transplantation for children with extensive soft-tissue defects below the knee in the extremities. Injury. 2012;43(6):822-828.
[9]Liu L, Tan G, Luan F, et al. The use of external fixation combined with vacuum sealing drainage to treat open comminuted fractures of tibia in the Wenchuan earthquake. Int Orthop. 2012;36(7):1441-1447.
[10]Mouës CM,van den Bemd GJ,Heule F,et al. Comparing conventional gauze therapy to vacuum-assisted closure wound therapy: a prospective randomised trial. J Plast Reconstr Aesthet Surg. 2007;60:672-681.
[11]Stöver B,Sigmund G,Langer M,et al.MRI in diagnostic evaluation of osteomyelitis in children. Eur Radiol. 1994; 4(4):347-352.
[12]Pape HC,Evans A,Kobbe P. Autologous Bone Graft: Properties and Techniques.J Orthop Trauma. 2010;24(3): 36-40.
[13]Qu J,Yan R,Wang L,et al.Free dermatoplasty combined with vacuum sealing drainage for the treatment of large-area soft tissue defects accompanied by bone exposure in the lower leg.Exp Ther Med. 2013;5(5): 1375-1380.
[14]裘华德.负压封闭引流技术[M].北京:人民卫生出版社,2003: 30-83.
[15]Chen CQ,Guo LX,Lin S,et al. Application of vacuum-sealing drainage in traumatic bone exposure of extremities. J Clin Orthop. 2009.
[16]Walter G. Treatment Algorithms for Chronic Osteomyelitis, Dtsch Arztebl Int. 2012; 109(14): 257-264.
[17]徐林.感染性骨与关节外科治疗[M]. 北京:人民卫生出版社, 2012:83-91.
[18]Ferguson PJ, Sandu M. Current Understanding of the Pathogenesis and Management of Chronic Recurrent Multifocal Osteomyelitis.Curr Rheumatol Rep. 2012;14(2): 130-141.
[19]Li RG, Ren GH, Hu JJ, et al. Free flap transplantation combined with skin grafting and vacuum sealing drainage for repair of circumferential or sub-circumferential soft-tissue wounds of the lower leg.Med Sci Monit. 2013;19:510-517.
[20]曹发奇,刘国辉.封闭负压引流术在创伤骨科修复中的应用研究[D]. 华中科技大学, 2010.
[21]Emara KM, Ghafar KA, Al Kersh MA. Methods to shorten the duration of an external fixator in the management of tibial infections. World J Orthop. 2011; 2(9): 85-92.