Successful treatment of infected wound dehiscence after minimally invasive locking-plate osteosynthesis of tibial pilon and calcaneal fractures by plate preservation, surgical debridement and antibiotics
•A combination of MIPO, plastic surgery and antibiotic therapy to the ankle is the treatment of choice in the prevention approach of the infected wound.•A combination of MIPO, plastic surgery and antibiotic therapy to the ankle that generated a decreased bacterial adhesion.•The patients responded po...
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| Veröffentlicht in: | Foot (Edinburgh, Scotland) Scotland), 2017-12, Vol.33, p.44-47 |
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| creator | Ieropoli, Giandavide Villafañe, Jorge Hugo Zompi, Silvia Chiara Morozzo, Umberto D’Ambrosi, Riccardo Usuelli, Federico Giuseppe Berjano, Pedro |
| description | •A combination of MIPO, plastic surgery and antibiotic therapy to the ankle is the treatment of choice in the prevention approach of the infected wound.•A combination of MIPO, plastic surgery and antibiotic therapy to the ankle that generated a decreased bacterial adhesion.•The patients responded positively to a combination of MIPO, plastic surgery and antibiotic therapy to the ankle.
The aim is to present a case series that illustrates possible benefits from combining minimally invasive plate osteosynthesis (MIPO), plastic surgery and antibiotic therapy, in order to treat and eradicate infection in patients with tibial pilon or calcaneal fractures.
Eleven consecutive patients with dehiscence of the surgical wound in outcomes MIPO using a Locking Compression Plate (LCP) for tibial pilon, or calcaneus fractures. The patients had developed a documented infection of the surgical wound. All patients were treated and followed-up by the multidisciplinary team with the orthopedic surgeon, the plastic surgeon and the infectious disease physician. All patients were followed by the plastic surgeon to treat the wound dehiscence, as well as by the orthopedic surgeon until fracture consolidation. The duration of the antibiotic therapy was from 4 to 6 months. After 6 weeks, the intravenous treatment was replaced by oral administration. The follow-up intervals were 15 days, 40 days, and 3 months.
The average time of wound closure was 109±60 days. The antibiotics used were chosen according to the antibiogram. The antibiotic therapy had a duration of 4–6 months, and after 6 weeks, the therapy switched to oral administration. At the 3-month follow-up, all patients had excellent outcomes and had returned to their normal activity of daily living.
The patients in this study responded positively to a combination of MIPO, plastic surgery and antibiotic therapy, confirming that multidisplinary treatment in association with titanium devices are able to eradicate infection in short time. |
| doi_str_mv | 10.1016/j.foot.2017.10.001 |
| format | Article |
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The aim is to present a case series that illustrates possible benefits from combining minimally invasive plate osteosynthesis (MIPO), plastic surgery and antibiotic therapy, in order to treat and eradicate infection in patients with tibial pilon or calcaneal fractures.
Eleven consecutive patients with dehiscence of the surgical wound in outcomes MIPO using a Locking Compression Plate (LCP) for tibial pilon, or calcaneus fractures. The patients had developed a documented infection of the surgical wound. All patients were treated and followed-up by the multidisciplinary team with the orthopedic surgeon, the plastic surgeon and the infectious disease physician. All patients were followed by the plastic surgeon to treat the wound dehiscence, as well as by the orthopedic surgeon until fracture consolidation. The duration of the antibiotic therapy was from 4 to 6 months. After 6 weeks, the intravenous treatment was replaced by oral administration. The follow-up intervals were 15 days, 40 days, and 3 months.
The average time of wound closure was 109±60 days. The antibiotics used were chosen according to the antibiogram. The antibiotic therapy had a duration of 4–6 months, and after 6 weeks, the therapy switched to oral administration. At the 3-month follow-up, all patients had excellent outcomes and had returned to their normal activity of daily living.
The patients in this study responded positively to a combination of MIPO, plastic surgery and antibiotic therapy, confirming that multidisplinary treatment in association with titanium devices are able to eradicate infection in short time.</description><identifier>ISSN: 0958-2592</identifier><identifier>EISSN: 1532-2963</identifier><identifier>DOI: 10.1016/j.foot.2017.10.001</identifier><identifier>PMID: 29126042</identifier><language>eng</language><publisher>Scotland: Elsevier Ltd</publisher><subject>Adult ; Ankle Fractures - diagnostic imaging ; Ankle Fractures - surgery ; Anti-Bacterial Agents - administration & dosage ; Bone Plates ; Calcaneaus ; Calcaneus - injuries ; Cohort Studies ; Combined Modality Therapy ; Debridement - methods ; Female ; Follow-Up Studies ; Foot ; Fracture Fixation, Internal - adverse effects ; Fracture Fixation, Internal - instrumentation ; Fracture Fixation, Internal - methods ; Fractures ; Fractures, Bone - diagnostic imaging ; Fractures, Bone - surgery ; Humans ; Infected wound ; Infusions, Intravenous ; Male ; Middle Aged ; Minimally invasive plate osteosynthesis ; Minimally Invasive Surgical Procedures - adverse effects ; Minimally Invasive Surgical Procedures - methods ; Osteosynthesis ; Retrospective Studies ; Risk Assessment ; Surgery, Plastic - methods ; Surgical Wound Dehiscence - therapy ; Surgical Wound Infection - diagnosis ; Surgical Wound Infection - therapy ; Tibial Fractures - diagnostic imaging ; Tibial Fractures - surgery ; Tibial pilon ; Treatment Outcome ; Wound Healing - physiology</subject><ispartof>Foot (Edinburgh, Scotland), 2017-12, Vol.33, p.44-47</ispartof><rights>2017 Elsevier Ltd</rights><rights>Copyright © 2017 Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c337t-4a4afd14bafb8bf46c9882ff595f1c233a9a7847d2eb8029d37b616078f770d73</citedby><cites>FETCH-LOGICAL-c337t-4a4afd14bafb8bf46c9882ff595f1c233a9a7847d2eb8029d37b616078f770d73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.foot.2017.10.001$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3549,27923,27924,45994</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29126042$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ieropoli, Giandavide</creatorcontrib><creatorcontrib>Villafañe, Jorge Hugo</creatorcontrib><creatorcontrib>Zompi, Silvia Chiara</creatorcontrib><creatorcontrib>Morozzo, Umberto</creatorcontrib><creatorcontrib>D’Ambrosi, Riccardo</creatorcontrib><creatorcontrib>Usuelli, Federico Giuseppe</creatorcontrib><creatorcontrib>Berjano, Pedro</creatorcontrib><title>Successful treatment of infected wound dehiscence after minimally invasive locking-plate osteosynthesis of tibial pilon and calcaneal fractures by plate preservation, surgical debridement and antibiotics</title><title>Foot (Edinburgh, Scotland)</title><addtitle>Foot (Edinb)</addtitle><description>•A combination of MIPO, plastic surgery and antibiotic therapy to the ankle is the treatment of choice in the prevention approach of the infected wound.•A combination of MIPO, plastic surgery and antibiotic therapy to the ankle that generated a decreased bacterial adhesion.•The patients responded positively to a combination of MIPO, plastic surgery and antibiotic therapy to the ankle.
The aim is to present a case series that illustrates possible benefits from combining minimally invasive plate osteosynthesis (MIPO), plastic surgery and antibiotic therapy, in order to treat and eradicate infection in patients with tibial pilon or calcaneal fractures.
Eleven consecutive patients with dehiscence of the surgical wound in outcomes MIPO using a Locking Compression Plate (LCP) for tibial pilon, or calcaneus fractures. The patients had developed a documented infection of the surgical wound. All patients were treated and followed-up by the multidisciplinary team with the orthopedic surgeon, the plastic surgeon and the infectious disease physician. All patients were followed by the plastic surgeon to treat the wound dehiscence, as well as by the orthopedic surgeon until fracture consolidation. The duration of the antibiotic therapy was from 4 to 6 months. After 6 weeks, the intravenous treatment was replaced by oral administration. The follow-up intervals were 15 days, 40 days, and 3 months.
The average time of wound closure was 109±60 days. The antibiotics used were chosen according to the antibiogram. The antibiotic therapy had a duration of 4–6 months, and after 6 weeks, the therapy switched to oral administration. At the 3-month follow-up, all patients had excellent outcomes and had returned to their normal activity of daily living.
The patients in this study responded positively to a combination of MIPO, plastic surgery and antibiotic therapy, confirming that multidisplinary treatment in association with titanium devices are able to eradicate infection in short time.</description><subject>Adult</subject><subject>Ankle Fractures - diagnostic imaging</subject><subject>Ankle Fractures - surgery</subject><subject>Anti-Bacterial Agents - administration & dosage</subject><subject>Bone Plates</subject><subject>Calcaneaus</subject><subject>Calcaneus - injuries</subject><subject>Cohort Studies</subject><subject>Combined Modality Therapy</subject><subject>Debridement - methods</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Foot</subject><subject>Fracture Fixation, Internal - adverse effects</subject><subject>Fracture Fixation, Internal - instrumentation</subject><subject>Fracture Fixation, Internal - methods</subject><subject>Fractures</subject><subject>Fractures, Bone - diagnostic imaging</subject><subject>Fractures, Bone - surgery</subject><subject>Humans</subject><subject>Infected wound</subject><subject>Infusions, Intravenous</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Minimally invasive plate osteosynthesis</subject><subject>Minimally Invasive Surgical Procedures - adverse effects</subject><subject>Minimally Invasive Surgical Procedures - methods</subject><subject>Osteosynthesis</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Surgery, Plastic - methods</subject><subject>Surgical Wound Dehiscence - therapy</subject><subject>Surgical Wound Infection - diagnosis</subject><subject>Surgical Wound Infection - therapy</subject><subject>Tibial Fractures - diagnostic imaging</subject><subject>Tibial Fractures - surgery</subject><subject>Tibial pilon</subject><subject>Treatment Outcome</subject><subject>Wound Healing - physiology</subject><issn>0958-2592</issn><issn>1532-2963</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc-OFCEQh4nRuLOrL-DBcPRgj0D_oTvxYjbqmmziQT0TGopdRhpaoMfMM_pSgrN69ESo_OpLVX0IvaBkTwkd3hz2JoS8Z4TyUtgTQh-hHe1b1rBpaB-jHZn6sWH9xC7QZUoHQkjPGHuKLthE2UA6tkO_vmxKQUpmczhHkHkBn3Ew2HoDKoPGP8PmNdZwb5MCrwBLkyHixXq7SOdOJXmUyR4Bu6C-W3_XrE5mwCFlCOnk8z0kmyoy29lKh1frgseyQJV0SnooNROlyluEhOcTPvev5QfxKLMN_jVOW7yzJV8GmaPV8GfMypC-YkO2Kj1DT4x0CZ4_vFfo24f3X69vmtvPHz9dv7ttVNvy3HSyk0bTbpZmHmfTDWoaR2ZMP_WGKta2cpJ87LhmMI-ETbrl80AHwkfDOdG8vUKvztw1hh8bpCyWehvnyi5hS4KW6zPORjaVKDtHVQwpRTBijeVs8SQoEVWiOIgqUVSJtVYklqaXD_xtXkD_a_lrrQTengNQtjxaiCIpW91oG4s0oYP9H_839wi04A</recordid><startdate>201712</startdate><enddate>201712</enddate><creator>Ieropoli, Giandavide</creator><creator>Villafañe, Jorge Hugo</creator><creator>Zompi, Silvia Chiara</creator><creator>Morozzo, Umberto</creator><creator>D’Ambrosi, Riccardo</creator><creator>Usuelli, Federico Giuseppe</creator><creator>Berjano, Pedro</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201712</creationdate><title>Successful treatment of infected wound dehiscence after minimally invasive locking-plate osteosynthesis of tibial pilon and calcaneal fractures by plate preservation, surgical debridement and antibiotics</title><author>Ieropoli, Giandavide ; Villafañe, Jorge Hugo ; Zompi, Silvia Chiara ; Morozzo, Umberto ; D’Ambrosi, Riccardo ; Usuelli, Federico Giuseppe ; Berjano, Pedro</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c337t-4a4afd14bafb8bf46c9882ff595f1c233a9a7847d2eb8029d37b616078f770d73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Ankle Fractures - diagnostic imaging</topic><topic>Ankle Fractures - surgery</topic><topic>Anti-Bacterial Agents - administration & dosage</topic><topic>Bone Plates</topic><topic>Calcaneaus</topic><topic>Calcaneus - injuries</topic><topic>Cohort Studies</topic><topic>Combined Modality Therapy</topic><topic>Debridement - methods</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Foot</topic><topic>Fracture Fixation, Internal - adverse effects</topic><topic>Fracture Fixation, Internal - instrumentation</topic><topic>Fracture Fixation, Internal - methods</topic><topic>Fractures</topic><topic>Fractures, Bone - diagnostic imaging</topic><topic>Fractures, Bone - surgery</topic><topic>Humans</topic><topic>Infected wound</topic><topic>Infusions, Intravenous</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Minimally invasive plate osteosynthesis</topic><topic>Minimally Invasive Surgical Procedures - adverse effects</topic><topic>Minimally Invasive Surgical Procedures - methods</topic><topic>Osteosynthesis</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Surgery, Plastic - methods</topic><topic>Surgical Wound Dehiscence - therapy</topic><topic>Surgical Wound Infection - diagnosis</topic><topic>Surgical Wound Infection - therapy</topic><topic>Tibial Fractures - diagnostic imaging</topic><topic>Tibial Fractures - surgery</topic><topic>Tibial pilon</topic><topic>Treatment Outcome</topic><topic>Wound Healing - physiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ieropoli, Giandavide</creatorcontrib><creatorcontrib>Villafañe, Jorge Hugo</creatorcontrib><creatorcontrib>Zompi, Silvia Chiara</creatorcontrib><creatorcontrib>Morozzo, Umberto</creatorcontrib><creatorcontrib>D’Ambrosi, Riccardo</creatorcontrib><creatorcontrib>Usuelli, Federico Giuseppe</creatorcontrib><creatorcontrib>Berjano, Pedro</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Foot (Edinburgh, Scotland)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ieropoli, Giandavide</au><au>Villafañe, Jorge Hugo</au><au>Zompi, Silvia Chiara</au><au>Morozzo, Umberto</au><au>D’Ambrosi, Riccardo</au><au>Usuelli, Federico Giuseppe</au><au>Berjano, Pedro</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Successful treatment of infected wound dehiscence after minimally invasive locking-plate osteosynthesis of tibial pilon and calcaneal fractures by plate preservation, surgical debridement and antibiotics</atitle><jtitle>Foot (Edinburgh, Scotland)</jtitle><addtitle>Foot (Edinb)</addtitle><date>2017-12</date><risdate>2017</risdate><volume>33</volume><spage>44</spage><epage>47</epage><pages>44-47</pages><issn>0958-2592</issn><eissn>1532-2963</eissn><abstract>•A combination of MIPO, plastic surgery and antibiotic therapy to the ankle is the treatment of choice in the prevention approach of the infected wound.•A combination of MIPO, plastic surgery and antibiotic therapy to the ankle that generated a decreased bacterial adhesion.•The patients responded positively to a combination of MIPO, plastic surgery and antibiotic therapy to the ankle.
The aim is to present a case series that illustrates possible benefits from combining minimally invasive plate osteosynthesis (MIPO), plastic surgery and antibiotic therapy, in order to treat and eradicate infection in patients with tibial pilon or calcaneal fractures.
Eleven consecutive patients with dehiscence of the surgical wound in outcomes MIPO using a Locking Compression Plate (LCP) for tibial pilon, or calcaneus fractures. The patients had developed a documented infection of the surgical wound. All patients were treated and followed-up by the multidisciplinary team with the orthopedic surgeon, the plastic surgeon and the infectious disease physician. All patients were followed by the plastic surgeon to treat the wound dehiscence, as well as by the orthopedic surgeon until fracture consolidation. The duration of the antibiotic therapy was from 4 to 6 months. After 6 weeks, the intravenous treatment was replaced by oral administration. The follow-up intervals were 15 days, 40 days, and 3 months.
The average time of wound closure was 109±60 days. The antibiotics used were chosen according to the antibiogram. The antibiotic therapy had a duration of 4–6 months, and after 6 weeks, the therapy switched to oral administration. At the 3-month follow-up, all patients had excellent outcomes and had returned to their normal activity of daily living.
The patients in this study responded positively to a combination of MIPO, plastic surgery and antibiotic therapy, confirming that multidisplinary treatment in association with titanium devices are able to eradicate infection in short time.</abstract><cop>Scotland</cop><pub>Elsevier Ltd</pub><pmid>29126042</pmid><doi>10.1016/j.foot.2017.10.001</doi><tpages>4</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0958-2592 |
| ispartof | Foot (Edinburgh, Scotland), 2017-12, Vol.33, p.44-47 |
| issn | 0958-2592 1532-2963 |
| language | eng |
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| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | Adult Ankle Fractures - diagnostic imaging Ankle Fractures - surgery Anti-Bacterial Agents - administration & dosage Bone Plates Calcaneaus Calcaneus - injuries Cohort Studies Combined Modality Therapy Debridement - methods Female Follow-Up Studies Foot Fracture Fixation, Internal - adverse effects Fracture Fixation, Internal - instrumentation Fracture Fixation, Internal - methods Fractures Fractures, Bone - diagnostic imaging Fractures, Bone - surgery Humans Infected wound Infusions, Intravenous Male Middle Aged Minimally invasive plate osteosynthesis Minimally Invasive Surgical Procedures - adverse effects Minimally Invasive Surgical Procedures - methods Osteosynthesis Retrospective Studies Risk Assessment Surgery, Plastic - methods Surgical Wound Dehiscence - therapy Surgical Wound Infection - diagnosis Surgical Wound Infection - therapy Tibial Fractures - diagnostic imaging Tibial Fractures - surgery Tibial pilon Treatment Outcome Wound Healing - physiology |
| title | Successful treatment of infected wound dehiscence after minimally invasive locking-plate osteosynthesis of tibial pilon and calcaneal fractures by plate preservation, surgical debridement and antibiotics |
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