One-stage treatment of chronic osteomyelitis with an antibiotic-loaded biocomposite and a local or free flap

Abstract

Background

Treatment of chronic osteomyelitis (OM) usually comprises surgical excision of infected bone and soft tissue, dead space management, and soft tissue closure. When soft tissue revision results in defects too large for direct closure, assistance from plastic surgeons is needed. This study reports outcomes for patients with OM treated by plastic and orthopedic surgeons in a one-stage operation with an antibiotic-loaded biocomposite (ALB) and a local or free flap.

Methods

We report a series of 11 consecutive patients with OM treated from February 2017 to September 2019. The treatment protocol included surgical debridement, tissue sampling, dead space management using ALB, stabilization as needed, and soft tissue closure with a local or free flap.

Results

Mean age at surgery was 62 years (39–79), mean BMI 28 kg/m2 (23–39). Multiple comorbidities were present. Local flaps were used in six patients, one reverse lateral arm flap, one soleus flap, two gastrocnemius flaps, one latissimus dorsi flap, and one fascia plantaris flap. Free flaps were used in five patients, three gracilis muscle flaps and two antero-lateral thigh (ALT) flaps. Mean follow-up was 28 months (15–42). Nine patients (81.8%) healed uneventfully after the one-stage surgical intervention, while two patients (18.2%) experienced partial or complete flap necrosis and required additional surgery. No patients required amputation, and no mortalities were reported.

Conclusions

One-stage treatment of OM using ALB, performed by a multidisciplinary team, led to zero amputations in a highly comorbid population, where amputation would otherwise have been unavoidable.

Level of evidence: Level IV, therapeutic study.

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Data availability

All data and materials comply with field standards.

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Authors

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Anne Kathrine Lorentzen and Magnús Pétur Bjarnason Obinah. The first draft of the manuscript was written by Anne Kathrine Lorentzen and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Anne Kathrine Lorentzen.

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Conflict of interest

Anne Kathrine Lorentzen, Lilan Engel, Hans Gottlieb, and Magnús Pétur Bjarnason Obinah declare that they have no conflicts of interest.

Ethical approval

The local research ethics committee has confirmed that no ethical approval is needed for this retrospective study.

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All required informed consent was obtained from patients, including signed informed consent regarding publishing photographs.

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No funding was received for this study.

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Lorentzen, A.K., Engel, L., Gottlieb, H. et al. One-stage treatment of chronic osteomyelitis with an antibiotic-loaded biocomposite and a local or free flap. Eur J Plast Surg 44, 367–374 (2021). https://doi.org/10.1007/s00238-020-01754-5

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Keywords

  • Osteomyelitis
  • Free flap
  • Local flap
  • Biocomposite