文献简介

出版社:Microsurgery

作  者:CURTIS L. CETRULO Jr.,ANGELO A. LETO BARONE, KATHLEEN JORDAN, DAVID S. CHANG, KEVIN LOUIE., RUDOLF F. BUNTIC, DARRELL BROOKS

编  号:DOI 10.1002/micr.20956

关键字:multi-disciplinary approach,management

年  份:2012   点击量:302

文献摘要

      Limb salvage in fungal osteomyelitis of the post-traumatic lower extremity represents a difficult clinical problem requiring aggressive management. We report lower extremity salvage by radical bony debridement, free tissue transfer, distraction osteogenesis with bone-docking, and a novel antifungal regimen in a clinical setting of infection with Scedosporium inflatum, historically requiring amputation in 100% of cases. We treated Scedosporium inflatum osteomyelitis of the tibia and calcaneus with radical debridement of infected bone, free partial medial rectus abdominis muscle flap coverage, transport distraction osteogenesis, and combination voriconazole/terbinafine chemotherapy, a novel antifungal regimen. We achieved successful control of the infection, limb salvage, and an excellent functional outcome through aggressive debridement of infected bone and soft tissue, elimination of dead space within the bony defect, the robust perfusion provided by the free flap, the hypervascular state induced by distraction osteogenesis, and the synergism of the novel antifungal regimen.

  创伤后下肢真菌骨髓炎保肢是一个临床难点问题,需要积极管理。我们报告了通过根治骨清创进行下肢保肢、游离组织移植、结合骨对接的牵张成骨术,以及在感染足放线病菌的临床环境中一种新型抗真菌治疗方案,根据以往观点所有病例需要截肢。我们采用根治性骨感染清创、游离偏内侧腹直肌肌皮瓣覆盖、输送盘牵张成骨术,并结合一种新型抗真菌(伏立康唑/特比萘芬化疗)治疗胫骨和跟骨足放线病菌骨髓炎。通过对受感染的骨与软组织的积极清创、消灭骨缺损内死腔、游离皮瓣提供的强大灌注、牵张成骨术引起的富血供状态及结合新型抗真菌治疗方案,我们成功控制了感染、保肢及获得了一个良好的功能预后。