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Repair of infected composite tissue wounds at the ankle or foot

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Author:
No author available
Journal Title:
Chinese Journal of Orthopaedic Trauma
Issue:
10
DOI:
10.3760/cma.j.issn.1671-7600.2012.10.008
Key Word:
引流术;软组织损伤;外科皮瓣;感染;Drainage;Soft tissue injuries;Surgical flaps;Infection

Abstract: Objective To evaluate the clinical outcomes of repairing infected composite tissue wounds at the ankle or foot using vacuum sealing drainage (VSD),OsteoSet Resorbable Mini-Bead Kit (RBK) implantation and skin or myocutaneous grafts. Methods Included in the present study were 120 patients with infected composite tissue wounds at the ankle or foot who had been treated in our department from March 2006 to March 2012.They were 100 males and 20 females,aged from 4 to 80 years (average,41.1 years).The time from injury to surgery ranged from one month to 3 years.The areas of soft tissue wound ranged from 3.0 cm × 1.5 cm to 23.0 cm × 12.0 cm.Twenty cases were treated with skin or myocutaneous flaps,57 cases with flaps plus RBK implantation,and 43 cases with flaps plus RBK plus autogenic iliac graft.Thorough debridement followed by VSD covering was used in 108 cases and thorough debridement followed by direct skin or myocutaneous grafting in 12 cases.If the internal fixation of ankle or foot fracture failed,external fixation was applied instead. Results All patients were followed up for 3 months to 5 years (average,15 months).Primary healing was achieved in 106 cases,and secondary healing in 14 cases.All the grafts survived well except 6 ones that had partial necrosis following pedicled transposition.Osteomyelitis was cured at one stage in 113 cases which obtained bone union after 4 to 8 months (average,5.2 months).Bone nonunion occurred in 3 cases which were cured with autogenic iliac graft after 6 to 8 months.Two cases of chronic calcaneal osteomyelitis experienced recurrence which was cured after secondary operation.Two other cases received secondary operation because of sinus tract formation after removal of drainage tube. Conclusion VSD,RBK implantation and skin or myocutaneous grafts are effective ways to treat infected composite tissue wounds at the ankle or foot.

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