The Effect of Age on Outcome in Excision of Chronic Osteomyelitis with Free Muscle Flap Reconstruction.

John Victor Kendall,Jamie Ferguson,Svetlana Galitzine,Alexander John Ramsden,Martin Mcnally,Henk Giele,Christopher Taylor,Paul Critchley

doi:10.7150/jbji.31764

Abstract

Introduction: Curative surgical treatment of chronic osteomyelitis often requires free tissue transfer if there is significant soft tissue compromise. We investigated whether age influenced outcomes of curative osteomyelitis excision in those patients requiring free muscle flap soft tissue reconstruction.Methods: We assessed ninety-five consecutive patients treated with excision of chronic osteomyelitis, skeletal stabilisation/reconstruction and free muscle transfer between 2006 and 2012. We compared outcomes of those aged ≥60 years (n=23) with those <60 years old (n=72).Results: Groups were similar with regard to Cierny and Mader anatomic type and physiological host classification. Length of procedure and length of hospital stay were similar for both groups. There was a greater proportion of ASA grade III patients in the older cohort. Infection recurrence occurred in one of the older cohort (4.3%) and in seven patients in the younger cohort (9.9%) at a mean follow-up of 42 months (range 11-131 months), this was not statistically significant (p=0.27874). There were five free flap losses (6.9%) in the younger group and none in the older group. A greater proportion of patients from the younger cohort required further unplanned surgery (28%) compared to the older group (4.3%), which was statistically significant (p=0.01174). Seven patients (7.4%) had serious medical complications - five of whom were in the younger cohort, including one mortality.Conclusions: Both the young and old can enjoy satisfactory outcomes from surgical resection of chronic osteomyelitis with simultaneous orthoplastic reconstruction including free tissue transfer. Age alone should not be a barrier to potentially curative surgical treatment.

Highlights

Curative surgical treatment of chronic osteomyelitis often requires free tissue transfer if there is significant soft tissue compromise
Chronic osteomyelitis is a debilitating condition associated with bone necrosis, soft tissue disruption and pain resulting in significant morbidity and loss of function
We identified 95 consecutive patients with chronic osteomyelitis requiring radical excision of necrotic bone and compromised soft tissues with free flap reconstruction

Summary

Introduction

Curative surgical treatment of chronic osteomyelitis often requires free tissue transfer if there is significant soft tissue compromise. We investigated whether age influenced outcomes of curative osteomyelitis excision in those patients requiring free muscle flap soft tissue reconstruction. Chronic osteomyelitis is a debilitating condition associated with bone necrosis, soft tissue disruption and pain resulting in significant morbidity and loss of function. Despite improvements in surgical technique, implant design and infection prophylaxis, the incidence of osteomyelitis is increasing[1]. It represents a significant complication of current orthopaedic practice and the legacy of injuries sustained decades before. Curative treatment involves complete excision of necrotic bone and compromised soft tissues[2], adequate representative sampling and diagnosis of the causative organism[3], ablation of dead space, skeletal stabilisation/reconstruction, reconstruction of soft tissue defects with vascularised tissue and targeted post-operative antibiotic therapy

Methods

Results

Conclusion