DOS 2019

DOS Kongressen 2019 · 171 The use of plastic surgery in single-stage treat- ment of chronic osteomyelitis Anne Kathrine Lorentzen, Janne Horn, Hans Gottlieb, Magnús Petúr Bjarnason Obinah Plastic Surgery, Herlev Hospital; Orthopedic Surgery, Herlev Hospital Background: Treatment of chronic osteomyelitis (OM) comprises surgical exci- sion of infected bone and soft tissue, dead space management, and subsequent soft tissue closure. When soft tissue revision results in defects too large for direct closure, assistance from plastic surgeons is needed. Purpose / Aim of Study: To report outcomes for patients with OM treated by plastic and orthopedic surgeons in a single-stage operation with an antibiotic loaded biocomposite (ALB) and soft tissue closure with a local or free flap. Materials and Methods: We report data on 11 patients with OM treated at our institution from 02/17 to 05/19. The treatment protocol included surgical debridement, dead-space management using ALB, and soft tissue closure with a local or free flap. The single- stage revision protocol was inspired by a recently published study. Findings / Results: Mean age at surgery was 62 yrs (33-79), mean BMI was 28 (23-39). Three were females. Five patients suffered from cardiovascu- lar disease, 2 were diabetics, and 7 had other comorbidities. Two were active smokers, and 3 had a history of smoking. Tibia was affected in 5 patients, while ulna, humerus, fibula and calcaneus were affected in the remaining patients. In 5 patients, OM followed surgical management of a closed fracture, 3 followed in open fractures, 1 arose after an overlying soft-tissue infection, 1 followed elective arthrodesis, and 1 was due to previous OM in the affected bone. Local flaps were used in 5 patients, including 1 reverse lateral arm flap, 1 soleus flap, 1 gastrocnemius flap, 1 latissimus dorsi flap, and 1 plantaris flap. Free flaps were used in 6 patients, 4 gracilis muscle flaps and 2 antero-lateral thigh flaps. Patients were followed up by chart review after a mean of 9 months (0-24). Two patients required a soft-tissue revision after 1 and 12 months, and two required bone revision and additional ALB after 7 and 10 months, respectively. No patients required amputation, and no mortalities were reported. Conclusions: Single-stage treatment of OM using ALB performed by plas- tic- and orthopedic surgeons led to zero amputations in a highly morbid patient population, where amputation would otherwise have been unavoidable. 127.