Clinical research of the one-stage treatment for traumatic osteomyelitis in tibia by combining flap, vancomycin-loaded calcium sulfate and autogenous iliac bone

Abstract

Objective To discuss the clinical effect of the phase-one treatment scheme for traumatic osteomyelitis in tibia by combining flap, vancomycin-loaded calcium sulfate and autogenous iliac bone. Methods From January, 2009 to July, 2014, 49 patients which had traumatic osteomyelitis in tibia and met the inclusive criteria were investigated and treated. By taking these patients as treatment group A(34 cases), they were treated by adopting the phase-one treatment scheme of combing tissue flap, vancomycin-loaded calcium sulfate and autogenous iliac bone. Fifteen patients who were treated by using the phase-one treatment scheme, namely, removing the lesion, implanting vancomycin-loaded calcium sulfate and repairing the defect by means of tissue flap, were chosen as control group B. Concerning treatment group A, drainage fluid was collected after operation every day to measure the concentration of vancomycin until drainage tube was removed. All the patients were followed up to study the following indexes: the standing time of drainage tube, the healing time of fracture, infection control rate, bone nonunion rate and other complications. Results All cases were followed up during 17 to 40 months after operation and no amputation was conducted for the affected limb. To repair soft tissue defect, flap and direct suture were adopted for 25 and 9 cases respectively in group A; The results indicated that all flaps survived, the poor healing of flap defect was observed for 2 cases which were healed after dressing change. However, to repair soft tissue defect, all group B cases used flaps; results revealed that distal flap necrosis was found in 2 cases applying neurocutaneous flap, with defect exudation and infection while the 2 cases were cured after debridement and dressing change without performing a second flap operation. In group A, 3 cases recurred during 5 months to 2 years after operation; in group B, it was 1; other complications included pintract infection, nonunion, numbness of anterolateral thigh, hematocele in iliac 1 region. In group B, refracture occurred for 2 cases at the original lesion location 18 and 25 months after healing and was cured after plate refixation and the graft of autogenous iliac bone; intraoperative pathology validated no recurrence of osteomyelitis. The standing time of drainage tube was (12.53±4.56) days on average for group A while (17.07±3.87) days for group B; The difference was statistically significant (P<0.05) . The healing time of fracture was (6.20±2.16) months on average for group A while(8.36±2.84) months for group B. The difference was statistically significant (P<0.05) . Conclusion In one stage treatment of localized and diffused traumatic osteomyelitis, the scheme of combining tissue flap, vancomycin-loaded calcium sulfate and autogenous iliac bone effectively shortened the healing time of fracture, increased the healing strength, and reduced the exudation after operation, without increasing infection recurrence rate. The scheme was superior to merely implanting vancomycin-loaded calcium sulfate. Key words: Surgical flap; Calcium sulfate; Vancomycin; Tibial osteomyelitis; Drug delivery