Grant Yonemoto, Timothy P Cheung, Steven D Vyce, Michael I Gazes
{"title":"真空辅助蛋壳型骨清除术与抗生素浸渍骨替代物植入术治疗钙骨骨髓炎及随后的夏科氏重建术:病例报告","authors":"Grant Yonemoto, Timothy P Cheung, Steven D Vyce, Michael I Gazes","doi":"10.7547/23-092","DOIUrl":null,"url":null,"abstract":"<p><p>Charcot's neuroarthropathy complicated by calcaneal osteomyelitis can be difficult to treat. Various surgical techniques describe how to manage these conditions. Eggshell-type debridement with application of antibiotic-impregnated bone substitute is a viable option that eliminates infected bone and allows staged reconstructive surgery. A 50-year-old woman with right midfoot Charcot's neuroarthropathy presented with osteomyelitis of the cuboid and fourth and fifth metatarsal bases after resection and failed antibiotic therapy. The patient eventually developed adductovarus, septic shock, and hematogenous osteomyelitis of the calcaneus, navicular, and lateral cuneiform. Vacuum-assisted eggshell-type debridement was performed, and the calcaneal defect was filled with antibiotic-impregnated calcium sulfate and calcium phosphate. Eight weeks after the initial surgery, the infection resolved; however, the patient had trouble walking. She underwent staged Charcot's reconstructive surgery with application of a dynamic multiplanar external fixator with gradual deformity and split-thickness skin graft to cover the residual plantar lateral foot wound. The second stage included septic fusion of the midfoot and subtalar joint from the frame. Twelve weeks postoperatively, radiographic union was achieved, the external fixator was removed, and the patient demonstrated a plantigrade foot. She was transitioned to a total-contact cast and allowed to bear weight as tolerated. Eighteen months after the initial procedure, the patient is wound-free and weightbearing in a CROW boot. This innovative eggshell-type debridement technique aspirates osteomyelitic cancellous bone while preserving cortical bone. It can be particularly useful in hematogenous osteomyelitis, where cortical integrity is not breached, or in situations where there is minimal cortical involvement. Specifically preserving the calcaneus, a major weightbearing bone, permits subsequent reconstructive surgical planning. At 18 months, there were no signs of osteomyelitis recurrence.</p>","PeriodicalId":17241,"journal":{"name":"Journal of the American Podiatric Medical Association","volume":null,"pages":null},"PeriodicalIF":0.5000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Vacuum-Assisted Eggshell-Type Bone Debridement with Implantation of Antibiotic-Impregnated Bone Substitute for Treatment of Calcaneal Osteomyelitis with Subsequent Charcot's Reconstruction: A Case Report.\",\"authors\":\"Grant Yonemoto, Timothy P Cheung, Steven D Vyce, Michael I Gazes\",\"doi\":\"10.7547/23-092\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Charcot's neuroarthropathy complicated by calcaneal osteomyelitis can be difficult to treat. Various surgical techniques describe how to manage these conditions. Eggshell-type debridement with application of antibiotic-impregnated bone substitute is a viable option that eliminates infected bone and allows staged reconstructive surgery. A 50-year-old woman with right midfoot Charcot's neuroarthropathy presented with osteomyelitis of the cuboid and fourth and fifth metatarsal bases after resection and failed antibiotic therapy. The patient eventually developed adductovarus, septic shock, and hematogenous osteomyelitis of the calcaneus, navicular, and lateral cuneiform. Vacuum-assisted eggshell-type debridement was performed, and the calcaneal defect was filled with antibiotic-impregnated calcium sulfate and calcium phosphate. Eight weeks after the initial surgery, the infection resolved; however, the patient had trouble walking. She underwent staged Charcot's reconstructive surgery with application of a dynamic multiplanar external fixator with gradual deformity and split-thickness skin graft to cover the residual plantar lateral foot wound. The second stage included septic fusion of the midfoot and subtalar joint from the frame. Twelve weeks postoperatively, radiographic union was achieved, the external fixator was removed, and the patient demonstrated a plantigrade foot. She was transitioned to a total-contact cast and allowed to bear weight as tolerated. Eighteen months after the initial procedure, the patient is wound-free and weightbearing in a CROW boot. This innovative eggshell-type debridement technique aspirates osteomyelitic cancellous bone while preserving cortical bone. It can be particularly useful in hematogenous osteomyelitis, where cortical integrity is not breached, or in situations where there is minimal cortical involvement. Specifically preserving the calcaneus, a major weightbearing bone, permits subsequent reconstructive surgical planning. At 18 months, there were no signs of osteomyelitis recurrence.</p>\",\"PeriodicalId\":17241,\"journal\":{\"name\":\"Journal of the American Podiatric Medical Association\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.5000,\"publicationDate\":\"2024-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the American Podiatric Medical Association\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.7547/23-092\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Podiatric Medical Association","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.7547/23-092","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Vacuum-Assisted Eggshell-Type Bone Debridement with Implantation of Antibiotic-Impregnated Bone Substitute for Treatment of Calcaneal Osteomyelitis with Subsequent Charcot's Reconstruction: A Case Report.
Charcot's neuroarthropathy complicated by calcaneal osteomyelitis can be difficult to treat. Various surgical techniques describe how to manage these conditions. Eggshell-type debridement with application of antibiotic-impregnated bone substitute is a viable option that eliminates infected bone and allows staged reconstructive surgery. A 50-year-old woman with right midfoot Charcot's neuroarthropathy presented with osteomyelitis of the cuboid and fourth and fifth metatarsal bases after resection and failed antibiotic therapy. The patient eventually developed adductovarus, septic shock, and hematogenous osteomyelitis of the calcaneus, navicular, and lateral cuneiform. Vacuum-assisted eggshell-type debridement was performed, and the calcaneal defect was filled with antibiotic-impregnated calcium sulfate and calcium phosphate. Eight weeks after the initial surgery, the infection resolved; however, the patient had trouble walking. She underwent staged Charcot's reconstructive surgery with application of a dynamic multiplanar external fixator with gradual deformity and split-thickness skin graft to cover the residual plantar lateral foot wound. The second stage included septic fusion of the midfoot and subtalar joint from the frame. Twelve weeks postoperatively, radiographic union was achieved, the external fixator was removed, and the patient demonstrated a plantigrade foot. She was transitioned to a total-contact cast and allowed to bear weight as tolerated. Eighteen months after the initial procedure, the patient is wound-free and weightbearing in a CROW boot. This innovative eggshell-type debridement technique aspirates osteomyelitic cancellous bone while preserving cortical bone. It can be particularly useful in hematogenous osteomyelitis, where cortical integrity is not breached, or in situations where there is minimal cortical involvement. Specifically preserving the calcaneus, a major weightbearing bone, permits subsequent reconstructive surgical planning. At 18 months, there were no signs of osteomyelitis recurrence.
期刊介绍:
The Journal of the American Podiatric Medical Association, the official journal of the Association, is the oldest and most frequently cited peer-reviewed journal in the profession of foot and ankle medicine. Founded in 1907 and appearing 6 times per year, it publishes research studies, case reports, literature reviews, special communications, clinical correspondence, letters to the editor, book reviews, and various other types of submissions. The Journal is included in major indexing and abstracting services for biomedical literature.