RESUMEN
PURPOSE: The objective of this study was to describe the use of retrograde gentamicin-coated tibial intramedullary nail (ETN PROtect™) in patients with tibial defects who required a tibiotalocalcaneal arthrodesis (TTC). METHODS: Consecutive series case review of seven men treated with TTC using retrograde PROtect™ between January 2018 and December 2023. The main outcomes evaluated were fracture union, complications, and the health-related quality of life using the EuroQol five-dimension three-level questionnaire (EQ-5D-3L). RESULTS: The mean age was 45.3 ± 8.0 years. Six patients had a clinical history of chronic osteomyelitis, and one case underwent TTC for congenital pseudoarthrosis. Fracture union was achieved in 5 of 7 patients between 4 and 11 months after surgery. Three patients developed complications; two patients had fistulas, and one had persistent pain. At the end of the follow-up, a median of 70 points (interquartile range: 60 to 90) on the EQ-5D-3L was reported. No complications directly attributed to the use of the PROtect™ were reported. CONCLUSION: TTC with retrograde PROtect™ is a prophylactic treatment option in patients with tibial defects treated with external fixation requiring a tibiotalar and subtalar arthrodesis. This novel use of PROtect™ allows simultaneous fixation of the tibiotalocalcaneal joint and protection of the regenerated bone, facilitating earlier rehabilitation in patients at high risk for postoperative infections.
Asunto(s)
Artrodesis , Clavos Ortopédicos , Gentamicinas , Osteomielitis , Tibia , Humanos , Artrodesis/métodos , Artrodesis/instrumentación , Artrodesis/efectos adversos , Masculino , Gentamicinas/administración & dosificación , Gentamicinas/uso terapéutico , Persona de Mediana Edad , Tibia/cirugía , Adulto , Osteomielitis/cirugía , Osteomielitis/etiología , Osteomielitis/prevención & control , Articulación del Tobillo/cirugía , Fijación Intramedular de Fracturas/instrumentación , Fijación Intramedular de Fracturas/métodos , Fijación Intramedular de Fracturas/efectos adversos , Antibacterianos/uso terapéutico , Antibacterianos/administración & dosificación , Seudoartrosis/cirugía , Seudoartrosis/prevención & control , Seudoartrosis/etiología , Calidad de Vida , Calcáneo/cirugíaRESUMEN
Introducción: La osteomielitis es una infección ósea, que afecta con frecuencia a pacientes en edades pediátricas, con comportamiento variado en dependencia de la vía de llegada al hueso, tipo de germen y respuesta del huésped. Objetivo: Describir el comportamiento de un grupo de pacientes pediátricos con osteomielitis. Método: Se realizó estudio observacional descriptivo en 39 pacientes atendidos en el Hospital Pediátrico Provincial Dr. Eduardo Agramonte Piña de la ciudad de Camagüey, en el periodo comprendido desde el primero de enero de 2018 al 31 de diciembre del año 2022, y un total de 60 meses con diagnóstico de osteomielitis. Resultados: De los 39 pacientes investigados predominó el sexo masculino sobre el femenino (2,2:1). La edad promedio fue de 9 años. El promedio de estadía hospitalaria fue de 14,8 días. Las zonas más afectadas fueron las manos, el fémur y tibia distal. Predominó el tratamiento quirúrgico (2,2:1) con relación al conservador. La vía hematógena de llegada al hueso fue la más frecuente en el 86,4 porciento de los casos. El paso a la cronicidad fue la complicación más encontrada (el 33 porciento). El germen aislado con mayor frecuencia fue el Staphylococcus aureus(en el 85 porciento de los enfermos). Los antimicrobianos más indicados fueron la cefazolina, amikacina y fosfocina. Conclusiones: Los resultados obtenidos en la investigación aportan elementos importantes desde el punto de vista epidemiológico en pacientes pediátricos que sufren de osteomielitis, lo que permite implementar estrategias de diagnósticas y terapéuticas en este grupo de pacientes.(AU)
Introduction: Osteomyelitis is an infection in the bone, most frequently affecting patients in pediatric ages, with a variety of behavior on how to reach the bone, type of germ and host response. Objective: To describe the behavior of a group of pediatric patients affected with osteomyelitis. Method: A descriptive observational study was conducted in 39 patients attended at the Hospital Provincial Pediátrico Dr. Eduardo Agramonte Piña in the city of Camagüey, from January 1 2018 to December 31 2022. Patients diagnosed with osteomyelitis throughout 60 months in total. Results: Of the 39 patients studied, the male sex predominated over the female (2.2 to 1). The average age was 9 years old. The average lenght of hospital stay was 14.8 days. The most affected areas were the hands, femur and distal tibia. Surgical treatment predominated (2.2 to 1) in relation to conservative treatment. In the 86.4 percent of cases, hematogenous osteomyelitis was the most frequent infection. The transition to chronic osteomyelitis was the most common complication (33 percent). The most common isolated germ was staphylococcus aureus (in 85 percent of the patients). The most indicated antimicrobials agents were cefazolin, amikacin and fostomycin (Fosfocin). Conclusions: The results of this research provided some important elements base on the epidemiological point of view for pediatric patients with osteomyelitis, also allowed the implementation of diagnostic and therapeutic strategies in this group of patients.(AU)
Introdução: A osteomielite é uma infeção óssea, que afecta frequentemente afecta frequentemente doentes do grupo etário pediátrico, com um comportamento variado, dependendo da via de entrada no osso, do tipo de germe e da resposta do hospedeiro. Objectivo: Mostrar o comportamento de um grupo de doentes pediátricos com osteomielite. Método: Foi realizado um estudo observacional descritivo em 39 pacientes tratados no Hospital Pediátrico Provincial Dr. Eduardo Agramonte Piña, na cidade de Camagüey, no período de 1 de janeiro de 2018 a 31 de dezembro de 2022, e um total de 60 meses com diagnóstico de osteomielite. Resultados: Dos 39 pacientes investigados, o sexo masculino predominou sobre o feminino (2,2 para 1). A idade média foi de 9 anos. A média de permanência hospitalar foi de 14,8 dias. As regiões mais acometidas foram as mãos, o fêmur e a tíbia distal. O tratamento cirúrgico predominou (2,2 para 1) sobre o tratamento conservador. A via hematogénica para o osso foi a mais frequente em 86,4 porcento dos casos. A transição para a cronicidade é a complicação mais frequentemente encontrada (33 porcento). O germe mais frequentemente isolado foi o Staphylococcus aureus (em 85 porcento dos doentes). Os antimicrobianos mais frequentemente indicados foram a cefazolina, a amicacina e a fosfocina. Conclusões: Os resultados obtidos na pesquisa fornecem elementos importantes do ponto de vista epidemiológico em pacientes pediátricos portadores de osteomielite, permitindo a implementação de estratégias diagnósticas e terapêuticas neste grupo de pacientes.(AU)
Asunto(s)
Humanos , Masculino , Femenino , Niño , Osteomielitis/cirugía , Osteomielitis/terapia , Osteomielitis/epidemiología , Pediatría , Estudios TransversalesRESUMEN
Sporotrichosis is the most frequent subcutaneous mycosis in Latin America. Sporothrix brasiliensis is the most virulent species, responsible for the majority of human and animal cases in Brazil. Osteomyelitis was described as a potential comorbidity of S. brasiliensis infection; however, surgical amputation resulting from an extracutaneous form is a rare outcome. In such cases, immunodeficiency and alcoholism must be investigated. We present two unusual cases of surgical amputation as a severe morbidity resulting from osteomyelitis by S. brasiliensis in immunocompetent nonalcoholic patients.
Asunto(s)
Osteomielitis , Sporothrix , Esporotricosis , Animales , Humanos , Amputación Quirúrgica , Brasil , Osteomielitis/diagnóstico por imagen , Osteomielitis/cirugía , Esporotricosis/diagnóstico , Esporotricosis/tratamiento farmacológico , Esporotricosis/cirugía , Femenino , AncianoRESUMEN
CASE: Two years after a right shoulder arthroscopic procedure, a 49-year-old woman presented with significant dysfunction and pain to our orthopaedic department. Laboratory and imaging evaluation demonstrated chronic glenohumeral osteomyelitis with irreparable damage to the humeral articular surface. A 2-stage soft-tissue shoulder interposition arthroplasty was performed to rebalance the joint. Long-term follow-up revealed functional results with pain control and no reinfection. CONCLUSION: For patients at high risk of reinfection or unable to undergo prosthetic joint implantation, this approach may be considered a functional alternative to salvage procedures.
Asunto(s)
Artroplastia de Reemplazo , Osteomielitis , Articulación del Hombro , Femenino , Humanos , Persona de Mediana Edad , Hombro/cirugía , Articulación del Hombro/cirugía , Húmero/cirugía , Dolor , Osteomielitis/cirugíaRESUMEN
AIMS: To report the case of chronic osteomyelitis of a maxilla in a woman with uncontrolled diabetes mellitus (DM), glucose-6-phosphate dehydrogenase (G6PD) deficiency and mental illness, in an attempt to clarify its pathogenesis and treatment. METHODS AND RESULTS: A case of a woman with moderate G6PD deficiency (Class III) who developed bilateral and asynchronous chronic suppurative osteomyelitis (CSO) of her maxilla with extensive bone sequestra, fistulae and whose management was performed by local surgery for bony sequestra and fistulae removal; closure communication under 4 weeks antibiotic cover. CONCLUSIONS: CSO of the jaw may be a complication of the G6PD deficiency and DM and its severity depends on patient's medical status.
Asunto(s)
Enfermedades Óseas , Diabetes Mellitus , Deficiencia de Glucosafosfato Deshidrogenasa , Osteomielitis , Femenino , Humanos , Maxilar , Osteomielitis/complicaciones , Osteomielitis/cirugíaRESUMEN
A Osteomielite dos Maxilares (OM) é uma inflamação óssea, de origem na maioria infecciosa, podendo atingir a porção medular e cortical dos ossos maxilares. Apresenta-se em maior extensão na mandíbula, devido ao pobre suprimento sanguíneo que essa possui, sendo mais prevalente em homens entre a faixa etária de 40 a 60 anos. Sua etiologia está relacionada principalmente às infecções odontogênicas, infecções secundárias e corpos estranhos ocasionais, como os implantes dentários. Tem-se por objetivo apresentar um relato de caso clínico sobre OM na região posterior da mandíbula, bem como sua associação a uma insatisfatória implantação dentária onde houve desenvolvimento de lesão peri-implantar. Paciente do gênero feminino, 53 anos, melanoderma, apresentou dor crônica, abaulamento ósseo sem outros sinais significativos na região de molares inferiores no lado direito, radiograficamente visualizava-se imagem mista sendo sugestiva de sequestro ósseo. Na história pregressa relatou ter realizado explantação na referida região após ser diagnosticada com peri implantite. Ao final do estudo concluiu-se que a afecção teve como causa a infecção bacteriana proveniente de contaminação durante a inserção de implante dentário. Optou-se por remoção cirúrgica do osso necrótico e inflamado... (AU)
Osteomyelitis of the Jaws (OM) is a bone inflammation, of mostly infectious origin, which can affect the medullary and cortical portion of the maxillary bones. It presents itself to a greater extent in the mandible, due to the poor blood supply that it has, being more prevalent in men between the age group of 40 to 60 years. Its etiology is mainly related to odontogenic infections, secondary infections and occasional foreign bodies, such as dental implants. The objective is to present a clinical case report on OM in the posterior region of the mandible, as well as its association with an unsatisfactory dental implantation, where there was development of a peri-implant lesion. Female patient, 53 years old, melanoderma, presented chronic pain, bone bulging without other significant signs in the region of lower molars on the right side, radiographically a mixed image was visualized, suggesting bone sequestration. In her previous history, she reported having performed explantation in that region after being diagnosed with peri-implantitis. At the end of the study, it was concluded that the disease was caused by bacterial infection from contamination during dental implant insertion. We opted for surgical removal of the necrotic and inflamed bone... (AU)
La osteomielitis de los maxilares (OM) es una inflamación de los huesos, en su mayoría de origen infeccioso, que puede afectar la porción medular y cortical de los huesos maxilares. Se presenta en mayor medida en la mandíbula, debido a la escasa irrigación sanguínea que tiene, siendo más prevalente en hombres entre el grupo de edad de 40 a 60 años. Su etiología se relaciona principalmente con infecciones odontogénicas, infecciones secundarias y cuerpos extraños ocasionales, como los implantes dentales. El objetivo es presentar un reporte de caso de OM en la región posterior de la mandíbula, así como su asociación con una implantación dentaria insatisfactoria a partir de la cual desarrollamos una lesión periimplantaria. Paciente femenina, 53 años, melanodermia, presenta dolor crónico, tumefacción ósea con otros signos significativos en región molar inferior del lado derecho, radiográficamente se visualiza imagen mixta sugestiva de pérdida ósea. En su historia previa menciona haber realizado una explantación en esa región tras ser diagnosticada de periimplantitis. Al final del estudio, se concluyó que la enfermedad fue causada por una infección bacteriana provocada por la contaminación durante la inserción del implante dental. Se optó por la extirpación quirúrgica de la piel necrótica e inflamada... (AU)
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Osteomielitis/cirugía , Enfermedades Maxilares/cirugía , Osteomielitis/etiología , Osteomielitis/diagnóstico por imagen , Enfermedades Maxilares/etiología , Enfermedades Maxilares/diagnóstico por imagen , Implantes Dentales/efectos adversos , Estudios Transversales , Periimplantitis/complicacionesRESUMEN
Five unrelated adult Colombian boas (Boa imperator) presented with a 1- to 3-mon history of unilateral rostral swelling of the maxilla associated with a chronic rubbing against the enclosure's walls. Moderate to severe gingival inflammation and ulceration of the labial mucosa were present at the level of the swelling with tenderness to the touch. Radiography revealed osteolytic or proliferative lesions of the maxillary bone. Chronic maxillary osteomyelitis was diagnosed. Unilateral maxillectomy was performed on each animal under general anesthesia. Local anesthesia was also achieved by infiltrating lidocaine along the medial and lateral aspect of the maxillary gingiva and at the level of the maxillo-ectopterygoid joint. Using a lateral gingival approach, the maxillo-prefrontal, maxillary-palatine, and maxillo-ectopterygoid attachments were transected, and the maxillary bone removed. Histologic examination revealed pyogranulomatous stomatitis and osteomyelitis in all snakes, and presence of intralesional bacteria (n = 3 snakes). Gram-negative bacteria (Chryseobacterium indologenes and Proteus mirabilis) were cultured from the resected tissue of two snakes. One snake suffered from wound dehiscence 5 d postoperatively. All snakes were fed 15 d postoperatively and ingested dead mice without apparent difficulties. One snake was examined 2 mon and 1 yr after surgery, with no evidence of soft tissue or osseous infection and only minor facial scaring; all other snakes were lost to follow-up 15 d after surgery. Unilateral maxillectomy was performed in a cohort of five Colombian boas suffering from maxillary osteomyelitis. This surgical technique should be considered as an alternative to medical treatment in boid snakes.
Asunto(s)
Boidae , Osteomielitis , Enfermedades de los Roedores , Animales , Estudios de Cohortes , Colombia , Lidocaína , Ratones , Osteomielitis/cirugía , Osteomielitis/veterinariaRESUMEN
El manejo de pseudoartrosis infectadas, osteomielitis y defectos óseos representa un reto enorme para el cirujano ortopedista. Hace diez años, Masquelet presentó la técnica de inducción de membrana como alternativa al manejo de las complicaciones mencionadas arriba con excelentes tasas de consolidación y erradicación del proceso infeccioso. Estudiamos una de serie de 14 casos, prospectiva, con seguimiento clínico y radiológico mínimo de 2 años (enero 2015-diciembre 2018), donde evaluamos múltiples variables en pacientes a quienes se les realizó el protocolo de Masquelet. Obtuvimos una tasa de consolidación de 85,7% (12/14). Con un tiempo promedio para alcanzarla de 6,1 meses (3-9m). Todos los pacientes que lograron la consolidación se encontraban libres de infección al final del seguimiento. Por su reproducibilidad y alta tasa de consolidación, consideramos la técnica de inducción de membrana, como una excelente opción en el manejo de pseudoartrosis infectadas complejas(AU)
The management of infected nonunions, osteomyelitis, and bone defects represents an enormous challenge for the orthopedic surgeon. Ten years ago, Masquelet presented the membrane induction technique as an alternative to the management of the complications afore mentioned with excellent rates of consolidation and eradication of the infectious process. We prospectively studied a series of 14 cases, with a clinical and radiological follow-up of at least 2 years (january 2015-december 2018). Where we evaluated multiple variables in patients who underwent the Masquelet protocol. We obtained a consolidation rate of 85.7% (12/14). With an average time to reach it of 6.1 months (3-9m). All patients who achieved union were free of infection at the end of follow-up. Due to its reproducibility and high consolidation rate, we consider the membrane induction technique an excellent option in the management of complex infected nonunions(AU)
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Osteomielitis/cirugía , Seudoartrosis/cirugía , Trasplante Óseo/métodos , Procedimientos de Cirugía Plástica/métodos , Estudios Prospectivos , Estudios de Seguimiento , Resultado del TratamientoRESUMEN
INTRODUCTION: Chronic osteomyelitis is a disease usually of infectious origin. The main cause is post-traumatic, it affects the bone tissue and surrounding tissue, the most frequent causative agent is Staphylococcus aureus. The most affected bone is the tibia. CASE DESCRIPTION: A 42-year-old male with a diagnosis of chronic tibia osteomyelitis, with sequelae of previous surgical interventions, multiple antibiotic treatments, and type IV B classification by Cierny-Mader. MATERIAL AND METHODS: Two-stage surgical management was chosen. Firstly, extensive bone and soft tissue debridement, placement of cement beads medicated with amikacin in the medullary cavity and osteoclast system for irrigation with vancomycin. In the second stage, free fibular bone grafting, fixation and stabilization with screws, bioactive glass placement in areas of interface between stabilized fibula and posterior tibial cortex. RESULTS: Before a multitratada chronic osteomyelitis it is necessary to individualize and evaluate treatment alternatives, in this case the surgical management in two time, the use of medication beads, bone graft and the use of bioactive glass, achieved a complete eradication of the infection and favorable clinical evolution with optimal functional recovery of affected limb.
INTRODUCCIÓN: La osteomielitis crónica es una enfermedad generalmente de origen infeccioso, la principal causa es postraumática, afecta el tejido óseo y el tejido circundante, el germen causal más frecuente es Staphylococcus aureus. El hueso más afectado es la tibia. DESCRIPCIÓN DEL CASO: Masculino de 42 años con diagnóstico de osteomielitis crónica de tibia, con secuelas de intervenciones quirúrgicas previas, múltiples tratamientos antibióticos y clasificación tipo IV B de Cierny-Mader. MATERIAL Y MÉTODOS: Se optó por un manejo quirúrgico en dos tiempos. En el primer tiempo, desbridamiento óseo extenso y de partes blandas, colocación de perlas de cemento medicado con amikacina en cavidad medular y sistema de osteoclisis para irrigación con vancomicina. En el segundo tiempo, colocación de injerto óseo peroné libre, fijación y estabilización con tornillos, colocación de vidrio bioactivo en zonas de interface entre peroné estabilizado y cortical posterior de tibia. RESULTADOS: Ante una osteomielitis crónica multitratada se tiene que individualizar y valorar alternativas de tratamiento; en este caso el manejo quirúrgico en dos tiempos, el uso de perlas de cemento, injerto óseo y el uso de vidrio bioactivo logró una erradicación de la infección y evolución clínica favorable con recuperación funcional de la extremidad afectada.
Asunto(s)
Osteomielitis , Tibia , Adulto , Antibacterianos/uso terapéutico , Cementos para Huesos/uso terapéutico , Trasplante Óseo/efectos adversos , Enfermedad Crónica , Desbridamiento/efectos adversos , Humanos , Masculino , Osteomielitis/cirugía , Tibia/cirugíaRESUMEN
La infección osteoarticular por microorganismos anaerobios es infrecuente, siendo la infección por fusobacterium nucleatum en niños muy rara. Se presenta el caso de un varón de 4 años que consulta por dolor, limitación funcional, y signos inflamatorios locales en la rodilla derecha de 1 mes de evolución, con ausencia de fiebre y sin antecedente traumático previo. Las pruebas de imagen objetivan una lesión lítica en cóndilo femoral externo con una colección en el espacio articular. Con el diagnóstico de osteomielitis en cóndilo femoral externo y artritis séptica de rodilla, se realizaron dos artroscopias consecutivas para desbridamiento articular y curetaje de la lesión. Se instauró terapia antibiótica intravenosa empírica y posteriormente específica tras el aislamiento de fusobacterium nucleatum. Fue necesario la identificación microbiológica mediante PCR universal 16S r ARN, ante la negatividad repetida de los cultivos.Tras 8 años de seguimiento el niño no presenta signos de infección local, las imágenes radiológicas del defecto osteocondral han mejorado y a la exploración muestra una correcta movilidad realizando una vida normal, incluso actividad deportiva. Tipo de Trabajo: Reporte de Caso. Nivel Evidencia: V
Osteoarticular infection by anaerobic microorganisms is infrequent in children, specially caused by Fusobacterium Nucleatum.A 4-year-old male patient that consults for pain, functional limitation and local inflammatory signs on the right knee, without fever for a 1-month, and no history of trauma. The radiological images showed a lytic lesion in the external femoral condyle with a collection in the joint space. After the diagnosis of osteomyelitis in external femoral condyle and septic arthritis of the knee, two consecutive arthroscopies were carried out for joint debridement and curettage of the lesion.Previously the isolation of fusobacterium nucleatum an empirical intravenous antibiotic therapy was instituted. Microbiological identification by 16S rRNA universal PCR was necessary in view of the repeated negativity of the cultures. Once the diagnosis is carried out, a more specific antibiotic treatment could be administered. After 8 years of follow-up, the child showed no signs of local infection, the radiological images of the osteochondral defect had improved. On physical examination the child presented a correct mobility leading a normal life and even doing sport. Type of Study: Case report. Level of Evidence: V
Asunto(s)
Preescolar , Osteomielitis/cirugía , Artroscopía/métodos , Artritis Infecciosa/cirugía , Fusobacterium nucleatum , Articulación de la Rodilla/patología , Estudios de Seguimiento , Resultado del TratamientoRESUMEN
PURPOSE: To describe a case report of FG associated with NPWT in the treatment of complex wound on the distal third of the lower limb with bone exposure. CASE REPORT: A 59-year-old patient with chronic left tibial osteomyelitis since childhood underwent extensive debridement of the distal tibial diaphysis (40% of bone thickness per 10 cm extension) and placement of bioactive glass S53P4. Distal necrosis occurred in the fasciocutaneous flap used as the primary bone coverage. After flap debridement, the case was resolved with FG, directly on the exposed bone and biomaterial, associated with NPWT. Three weeks after the first FG session over bony tissue, 100% granulation was achieved with NPWT. The closure was completed with thin laminated skin graft over the granulated wound area. DISCUSSION: The association of FG and NPWT is not known in the clinical practice. Except for the only one experimental study described by Kao et al.4, the theme was not addressed in the medical literature before. In this clinical case, the result obtained regarding the granulation tissue formation drew attention and prevented the use of more complex flaps such as the microsurgical ones. Accelerated granulation tissue formation was observed, filling an extensive and deep bone defect, even with infected bone and biomaterial. Low morbidity and no complications were observed with the use of FG associated with NPWT. When the grafted fat was compacted with the NPWT, it seemed to behave as a true autologous biological matrix with large amount of cells. To date, scientific studies on fat grafting have focused on the cellular aspect (adipocytes and mesenchymal cells), growth factors and fat differentiation in different tissues. The property of aspirated adipose tissue as a biological matrix seemed to be revealed by the application of NPWT in association with FG. This new roll for the aspirated fat tissue may represent a new research field in plastic surgery.
Asunto(s)
Tejido Adiposo/trasplante , Terapia de Presión Negativa para Heridas/métodos , Osteomielitis/cirugía , Cicatrización de Heridas , Vidrio , Humanos , Masculino , Persona de Mediana Edad , Colgajos QuirúrgicosRESUMEN
OBJECTIVE: We describe the case of a diabetic patient who developed vertebral osteomyelitis and bilateral psoas abscess with gas formation due to klebsiella pneumoniae. METHODS: A 64-year-old woman with a 4-year history of type-2 diabetes mellitus was admitted to the Emergency Department. The subject had a 2-day history of high-grade fever associated with chills and a 5-hour history of consciousness. She received empirical treatment with febrifuge, after which her fever decreased. RESULTS: Her fever recurred after an interval of three hours. A computed tomography scan of the abdomen revealed vertebral osteomyelitis and bilateral psoas muscle abscess with gas formation. Blood culture and purulent fluid described the growth of the Klebsiella pneumoniae. The patient received antibiotic therapy and bilateral drainage therapy after the drainage catheter was placed into the abscess cavity by CT-guidance. Due to the serious damage to the vertebral column and permanent pain, the patient underwent minimally invasive internal spinal fixation and recovered successfully. CONCLUSION: A case of vertebral osteomyelitis and bilateral psoas abscess with gas formation caused by Klebsiella pneumoniae in a diabetic patient. Antibiotic therapy, drainage, and minimally invasive internal spinal fixation were performed, which enabled a good outcome.
Asunto(s)
Complicaciones de la Diabetes/cirugía , Infecciones por Klebsiella/cirugía , Klebsiella pneumoniae/patogenicidad , Osteomielitis/cirugía , Absceso del Psoas/cirugía , Enfermedades de la Columna Vertebral/cirugía , Complicaciones de la Diabetes/microbiología , Drenaje/métodos , Femenino , Gases/metabolismo , Humanos , Infecciones por Klebsiella/microbiología , Persona de Mediana Edad , Osteomielitis/microbiología , Absceso del Psoas/microbiología , Reproducibilidad de los Resultados , Enfermedades de la Columna Vertebral/microbiología , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
SUMMARY OBJECTIVE: We describe the case of a diabetic patient who developed vertebral osteomyelitis and bilateral psoas abscess with gas formation due to klebsiella pneumoniae. METHODS: A 64-year-old woman with a 4-year history of type-2 diabetes mellitus was admitted to the Emergency Department. The subject had a 2-day history of high-grade fever associated with chills and a 5-hour history of consciousness. She received empirical treatment with febrifuge, after which her fever decreased. RESULTS: Her fever recurred after an interval of three hours. A computed tomography scan of the abdomen revealed vertebral osteomyelitis and bilateral psoas muscle abscess with gas formation. Blood culture and purulent fluid described the growth of the Klebsiella pneumoniae. The patient received antibiotic therapy and bilateral drainage therapy after the drainage catheter was placed into the abscess cavity by CT-guidance. Due to the serious damage to the vertebral column and permanent pain, the patient underwent minimally invasive internal spinal fixation and recovered successfully. CONCLUSION: A case of vertebral osteomyelitis and bilateral psoas abscess with gas formation caused by Klebsiella pneumoniae in a diabetic patient. Antibiotic therapy, drainage, and minimally invasive internal spinal fixation were performed, which enabled a good outcome.
RESUMO OBJETIVO: Descrever o caso de uma paciente diabética que desenvolveu osteomielite vertebral e abcesso bilateral do psoas com formação de gás causada por klebsiella pneumoniae. MÉTODOS: Uma mulher de 64 anos de idade, com 4 anos de histórico de diabetes mellitus tipo 2, foi admitida no Serviço de Emergência. A paciente apresentava um quadro de dias de febre alta acompanhada de calafrios e um histórico de 5 horas de consciência. Ela recebeu tratamento empírico com antitérmico, após o qual a febre diminuiu. RESULTADOS: A febre retornou após um intervalo de três horas. Uma tomografia computadorizada do abdome revelou osteomielite vertebral e abcesso bilateral do músculo psoas com formação de gás. A cultura do sangue e o fluido purulento revelaram o crescimento de Klebsiella pneumoniae. A paciente recebeu antibióticos e terapia de drenagem bilateral após o cateter de drenagem ser posicionado na cavidade do abscesso com auxílio de TC. Devido a sérios danos à coluna vertebral e a dor permanente, a paciente foi submetida à fixação vertebral interna minimamente invasiva e recuperou-se com sucesso. CONCLUSÃO: Um caso de osteomielite vertebral e abscesso do psoas bilateral com a formação de gás causada por Klebsiella pneumoniae em uma paciente diabética. Antibioticoterapia, drenagem e fixação vertebral interna minimamente invasiva foram realizadas, o que permitiu um bom resultado.
Asunto(s)
Humanos , Femenino , Osteomielitis/cirugía , Enfermedades de la Columna Vertebral/cirugía , Infecciones por Klebsiella/cirugía , Absceso del Psoas/cirugía , Complicaciones de la Diabetes/cirugía , Klebsiella pneumoniae/patogenicidad , Osteomielitis/microbiología , Enfermedades de la Columna Vertebral/microbiología , Infecciones por Klebsiella/microbiología , Tomografía Computarizada por Rayos X/métodos , Drenaje/métodos , Reproducibilidad de los Resultados , Resultado del Tratamiento , Absceso del Psoas/microbiología , Complicaciones de la Diabetes/microbiología , Gases/metabolismo , Persona de Mediana EdadRESUMEN
Abstract Purpose: To describe a case report of FG associated with NPWT in the treatment of complex wound on the distal third of the lower limb with bone exposure. Case Report: A 59-year-old patient with chronic left tibial osteomyelitis since childhood underwent extensive debridement of the distal tibial diaphysis (40% of bone thickness per 10 cm extension) and placement of bioactive glass S53P4. Distal necrosis occurred in the fasciocutaneous flap used as the primary bone coverage. After flap debridement, the case was resolved with FG, directly on the exposed bone and biomaterial, associated with NPWT. Three weeks after the first FG session over bony tissue, 100% granulation was achieved with NPWT. The closure was completed with thin laminated skin graft over the granulated wound area. Discussion: The association of FG and NPWT is not known in the clinical practice. Except for the only one experimental study described by Kao et al.4, the theme was not addressed in the medical literature before. In this clinical case, the result obtained regarding the granulation tissue formation drew attention and prevented the use of more complex flaps such as the microsurgical ones. Accelerated granulation tissue formation was observed, filling an extensive and deep bone defect, even with infected bone and biomaterial. Low morbidity and no complications were observed with the use of FG associated with NPWT. When the grafted fat was compacted with the NPWT, it seemed to behave as a true autologous biological matrix with large amount of cells. To date, scientific studies on fat grafting have focused on the cellular aspect (adipocytes and mesenchymal cells), growth factors and fat differentiation in different tissues. The property of aspirated adipose tissue as a biological matrix seemed to be revealed by the application of NPWT in association with FG. This new roll for the aspirated fat tissue may represent a new research field in plastic surgery.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Osteomielitis/cirugía , Cicatrización de Heridas , Tejido Adiposo/trasplante , Terapia de Presión Negativa para Heridas/métodos , Colgajos Quirúrgicos , VidrioRESUMEN
A hemicorporectomia ou amputação translombar foi primeiramente descrita em 1950 por Kredel como método curativo para neoplasia localmente avançada de pelve. Trata-se de um procedimento cirúrgico extenso, que quando bem indicado é capaz de prover a cura oncológica, além de possibilitar a melhora clínica e de qualidade de vida. Os autores apresentam o relato de caso de um paciente de 34 anos, com carcinoma espinocelular em úlcera de pressão crônica, acometendo períneo, glúteo e coxa posterior à direita. O paciente foi submetido à hemicorporectomia com reconstrução utilizando retalho subtotal da coxa esquerda. Observou-se boa evolução no pós-operatório e a utilização do retalho subtotal da coxa para fechamento da hemicorporectomia se mostrou como método seguro, eficiente e de técnica reprodutível.
Hemicorporectomy or translumbar amputation was first described in 1950 by Kredel to treat locally advanced pelvic neoplasia. This extensive surgical procedure can achieve oncological cure and improve clinical status and quality of life. The authors present a case report of a 34-yearold patient with squamous cell carcinoma in a chronic pressure ulcer affecting the right perineum, gluteus, and posterior thigh. The patient underwent hemicorporectomy with reconstructive surgery using a partial-thickness flap of the left thigh. The postoperative course was good, and the use of a partial-thickness flap of the thigh to close the hemicorporectomy proved to be safe, efficient, and reproducible.
Asunto(s)
Humanos , Masculino , Adulto , Historia del Siglo XXI , Osteomielitis , Paraplejía , Colgajos Quirúrgicos , Carcinoma de Células Escamosas , Procedimientos de Cirugía Plástica , Úlcera por Presión , Cadera , Amputación Quirúrgica , Osteomielitis/cirugía , Osteomielitis/terapia , Paraplejía/cirugía , Paraplejía/complicaciones , Paraplejía/diagnóstico , Colgajos Quirúrgicos/cirugía , Colgajos Quirúrgicos/efectos adversos , Carcinoma de Células Escamosas/cirugía , Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/terapia , Procedimientos de Cirugía Plástica/métodos , Úlcera por Presión/cirugía , Úlcera por Presión/fisiopatología , Cadera/cirugía , Amputación Quirúrgica/métodosRESUMEN
OBJECTIVE: The aim of this study was to compare the expression of proliferative markers and apoptosis-associated proteins in the oral mucosa adjacent to bone sequestrum associated with osteonecrosis (ON) of the jaws and florid osseous dysplasia (OD). STUDY DESIGN: Oral mucosal samples derived from surgical procedures performed for treatment of ON and OD (10 cases each) were retrieved. Histologic analysis was done on hematoxylin and eosin-stained slides; immunohistochemical reactions against epidermal growth factor (EGF), keratinocyte growth factor (KGF), vascular endothelial growth factor (VEGF), Bcl-2 protein, interleukin-6 (IL-6), and Ki-67 antigen were performed with the immunoperoxidase technique. RESULTS: The epithelium was hyperplastic in 60% and 22% of ON and OD samples, respectively. Cytoplasmic EGF and KGF expression; Bcl-2, VEGF, and IL-6 expressions; and the mean epithelial proliferative index were not statistically different between the 2 groups. Membranous EGF expression was more evident in samples showing hyperplastic epithelium. CONCLUSIONS: Exposure to bisphosphonates did not alter the expression of KGF, EGF, VEGF, Bcl-2, IL-6, and the epithelial proliferating index in comparison with inflamed oral mucosa not exposed to bisphosphonates.
Asunto(s)
Osteonecrosis de los Maxilares Asociada a Difosfonatos/metabolismo , Factor de Crecimiento Epidérmico/metabolismo , Epitelio/metabolismo , Factor 7 de Crecimiento de Fibroblastos/metabolismo , Displasia Fibrosa Ósea/metabolismo , Antígeno Ki-67/metabolismo , Mucosa Bucal/metabolismo , Osteomielitis/metabolismo , Proteínas Proto-Oncogénicas c-bcl-2/metabolismo , Factor A de Crecimiento Endotelial Vascular/metabolismo , Anciano , Biomarcadores/metabolismo , Osteonecrosis de los Maxilares Asociada a Difosfonatos/cirugía , Femenino , Displasia Fibrosa Ósea/cirugía , Humanos , Técnicas para Inmunoenzimas , Masculino , Persona de Mediana Edad , Osteomielitis/cirugíaRESUMEN
ABSTRACT: Osteomyelitis is an infection that affects bone and bone marrow, it occurs due to inoculation of microorganisms either directly or by continuous accumulation through a hematogenous way. Female patient, 64 years old, presenting an increase of volume of the parotid masseteric region and right submandibular region, with approximately two weeks of evolution, which had a slightly fluctuating, hyperemic and hyperthermic indurated consistency; the patient complained of severe pain. CT scan and biopsy was indicated. It is imperative to identify the causative agent; the use of antibiotics must be complemented by surgical treatment to eliminate the possibility of a remaining infection.
RESUMEN: La osteomielitis es un proceso infeccioso que afecta al hueso y medula ósea y que se produce debido a la inoculación de microorganismos ya sea de manera directa, por continuidad o bien por medio de la vía hematógena. Paciente femenino de 64 años de edad que presentaba aumento de volumen en región submandibular derecha refiriendo dolor intenso con evolución de 2 semanas aproximadamente, el cual era de consistencia indurada ligeramente fluctuante, hiperémico e hipertérmico; la paciente se quejaba de dolor intenso, se indicó TC y biopsia. En estos casos para tener éxito en el tratamiento el uso de antibióticos debe complementarse con desbridamiento quirúrgico, aunado a un seguimiento estrecho para descartar la posibilidad de una infección remanente.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Osteomielitis/diagnóstico , Enfermedades Mandibulares/diagnóstico , Osteomielitis/cirugía , Osteomielitis/tratamiento farmacológico , Osteonecrosis/diagnóstico , Absceso Periapical/diagnóstico , Supuración , Radiografía Panorámica , Enfermedades Mandibulares/cirugía , Enfermedades Mandibulares/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Enfermedad Crónica , Fístula Dental/diagnóstico , Desbridamiento , Estudios Controlados Antes y Después , Antibacterianos/uso terapéuticoRESUMEN
Introdução: As complicações de ferida operatória após esternotomia para acessos cirúrgicos para procedimentos cardiovasculares variam desde pequenas deiscências até mediastinite e osteomielite do esterno. Mediastinite e osteomielite do esterno associam-se a alto risco, alta morbidade e altas taxas de mortalidade, além de altas taxas de recidiva. O tratamento nos casos de maior gravidade envolvem internação hospitalar prolongada. A utilização de antibióticos por tempo prolongado, durante a internação, e após a alta, tem impacto importante no custo global do tratamento. Mais recentemente, uma opção de tratamento envolve o amplo debridamento cirúrgico da ferida em centro cirúrgico, preparo do leito da ferida com terapia por pressão negativa, seguida do fechamento da ferida com retalhos miocutâneos ou fasciocutâneos. Aparentemente, essa estratégia traz vantagens como a melhora na qualidade de vida do paciente, menor manipulação e menor incômodo ao doente, menos sobrecarga para os profissionais de saúde envolvidos nos cuidados, menor taxa de recidiva infecciosa e, assim, redução da morbidade do tratamento como um todo. Métodos: O presente estudo tem por objetivo realizar levantamento dos pacientes vítimas dessa grave complicação que tenham sido tratados segundo protocolo desenvolvido e aprimorado no Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor - HCFMUSP), e que tenham sido operados por um mesmo cirurgião plástico, a fim de analisar o perfil epidemiológico, e eventual indicador de pior prognóstico dentre os exames colhidos habitualmente desses pacientes. Foram avaliados, retrospectivamente, os prontuários dos pacientes atendidos no InCor - HCFMUSP vítimas de infecção de esternotomia durante o ano de 2014. As variáveis analisadas foram comorbidades, intervalo entre abordagens cirúrgicas, valores de Proteína C Reativa (PCR), procedimento empregado no fechamento da ferida, complicações do tratamento, entre outros. Resultados: Os dados são essencialmente descritivos e de caráter epidemiológico: observa-se a incidência de ao menos uma comorbidade em 84% dos pacientes; média de 2,5 procedimentos cirúrgicos por paciente, variando de 1 a 7 procedimentos; queda nos níveis de PCR em 75% dos pacientes já após o primeiro procedimento cirúrgico e mortalidade de 17%, entre outros dados. Conclusão: Os dados analisados nos permitem concluir que o método padronizado adotado trouxe impacto na redução da mortalidade global dos pacientes, além da redução de recidiva e reinternações. Identificamos, ainda, indicadores de pior prognóstico como PCR e leucograma no momento do diagnóstico e indicação da aplicação do protocolo.
Introduction: Surgical wound complications after sternotomy in cardiovascular procedures include small dehiscences, mediastinitis, and sternal osteomyelitis. Mediastinitis and sternal osteomyelitis are high-risk complications associated with high rates of morbidity, mortality, and recurrence. Treatment of the most severe cases involves prolonged hospitalization. Moreover, the long-term use of antibiotics during hospitalization and after discharge significantly increases the overall cost of treatment. A recent treatment option involves extensive surgical debridement of the surgical wound, treatment of the wound bed with negative pressure therapy, and closure of the wound with myocutaneous or fasciocutaneous flaps. The advantages of this strategy include improvement of the patient's quality of life, less manipulation and less discomfort for the patient, less burden on staff involved in care, lower rate of infection recurrence, and an overall reduction of treatment morbidity. Methods: The objective of this study was to conduct a retrospective survey of patients with surgical wound complications who were treated according to a protocol developed and improved by the Heart Institute of the Clinic Hospital of the School of Medicine of the University of São Paulo (Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInCor/HC-FM-USP), and who underwent surgery by the same plastic surgeon. The epidemiological profiles and possible indicators of worse prognosis were determined from routine examinations performed on these patients. The medical records of patients treated at InCor/HC-FM-USP who presented with sternotomy infection in 2014 were assessed retrospectively. The analyzed variables included comorbidities, interval between surgical procedures, C-reactive protein (CRP) levels, wound closure procedures, and treatment complications, among others. Results: The data are predominantly descriptive and epidemiological. At least one comorbidity was present in 84% of cases. The mean number of surgical procedures per patient was 2.5, ranging from 1 to 7. The CRP levels decreased in 75% of patients after the first surgical procedure, and the mortality rate was 17%. Conclusion: The standardized method adopted significantly decreased the overall mortality and the rates of recurrence and readmission. Indicators of worse prognosis, including CRP levels and the leukogram, were identified at the time of diagnosis and initiation of the treatment protocol.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Historia del Siglo XXI , Osteomielitis , Pacientes , Complicaciones Posoperatorias , Colgajos Quirúrgicos , Infección de la Herida Quirúrgica , Heridas y Lesiones , Registros Médicos , Reacción en Cadena de la Polimerasa , Estudios Retrospectivos , Terapia de Presión Negativa para Heridas , Mediastinitis , Osteomielitis/cirugía , Osteomielitis/complicaciones , Osteomielitis/terapia , Pacientes/psicología , Complicaciones Posoperatorias/terapia , Colgajos Quirúrgicos/cirugía , Infección de la Herida Quirúrgica/terapia , Heridas y Lesiones/cirugía , Heridas y Lesiones/complicaciones , Heridas y Lesiones/terapia , Registros Médicos/normas , Reacción en Cadena de la Polimerasa/métodos , Interpretación Estadística de Datos , Terapia de Presión Negativa para Heridas/métodos , Mediastinitis/cirugía , Mediastinitis/terapiaRESUMEN
Resumen: La infección ósea y la seudoartrosis son las principales complicaciones ortopédicas en cuyo tratamiento intervienen múltiples factores en la tasa de falla al tratar de corregirlas. Conocer estos factores fue el problema que originó la investigación a través de un estudio longitudinal y prospectivo de una cohorte histórica de 83 pacientes de 43.3 ± 16.1 años de edad tratados por seudoartrosis asépticas y sépticas, osteomielitis, osteítis, consolidación viciosa o prótesis infectadas, el desenlace se relacionó con los factores pronósticos sistémicos y locales tomados del modelo de Cierny-Mader como factores que afectan la vigilancia inmunológica, el metabolismo y la vascularización local. Para el análisis bivariado se aplicó χ2 o el test exacto de Fisher; para el análisis multivariado se aplicó el modelo de regresión logística binaria no condicional con método de Wald hacia atrás para seleccionar los factores pronósticos significativos. El error alfa se fijó ≤ 0.05. Las complicaciones se presentaron en 51.8% de los casos. Los factores locales (linfedema, arteritis, insuficiencia venosa y pérdida de piel) con una OR de 5.0 (IC 95% 1.0-24.9, p = 0.03), las seudoartrosis sépticas con OR de 5.0 (IC 95% 1.9-13.0, p = 0.001) y fracturas segmentarias con OR de 3.2 (IC 95% 0.8-13.0, p = 0.07) fueron los factores pronósticos identificados en el análisis bivariado; sin embargo, la regresión logística sólo seleccionó como factor significativo a las seudoartrosis sépticas. Es necesario detectar y en su caso controlar o eliminar dichos factores que pueden incidir directamente en malos resultados postquirúrgicos.
Abstract: Bone infection and nonunion are the main orthopedic and traumatic complications whose treatment remains a challenge because multiple factors are involved in the rate of failures when you try to correct them. Knowing these factors were the problem that caused the research through a prospective longitudinal study of 83 patients of 43.3 ± 16.1 years old. They were treated for aseptic and septic nonunion, osteomyelitis, osteitis, malunion or infected joint replacement. The cases were classified with or without postoperative complications and outcome related to systemic and local factors taken prognostic model Cierny-Mader as factors affecting immune surveillance, metabolism and local vascularization. For bivariate analysis of data χ2 it was applied or where appropriate Fisher's exact test; for multivariate analysis model not conditional binary logistic regression method was applied Wald backward to select the significant prognostic factors. The alpha error was set ≤ 0.05. General complications occurred in 51.8% of cases. Local factors (lymphedema, arteritis, venous insufficiency, loss of skin) with an OR of 5.0 (95% CI 1.0-24.9, p = 0.03), septic nonunion with OR of 5.0 (95% CI 1.9-13.0, p = 0.001) and segmental fractures with an OR of 3.2 (95% CI 0.8-13.0, p = 0.07) were the prognostic factors identified in the bivariate analysis; however, the logistic regression only selected as the septic pseudoarthrosis as a significant factor. It is necessary to detect and if necessary control or eliminate those factors that can directly affect poor postoperative results.
Asunto(s)
Humanos , Adulto , Osteomielitis/cirugía , Complicaciones Posoperatorias , Seudoartrosis , Diástasis Ósea/etiología , Infecciones/etiología , Pronóstico , Estudios Prospectivos , Estudios Retrospectivos , Estudios Longitudinales , Resultado del Tratamiento , Persona de Mediana EdadRESUMEN
La osteomielitis se define como una inflamación progresiva del hueso, que se produce con mayor frecuencia en los huesos largos del cuerpo. Su etiología se relaciona con factores locales y/o sistémicos los que incluyen la anemia. La osteomielitis resultante de la anemia de células falciformes genera que la sangre sea más viscosa produciendo un bajo flujo sanguíneo conduciendo a infarto isquémico y necrosis del hueso, rara vez causado en los huesos faciales. Paciente ingresado a urgencia por un aumento de volumen en la región preauricular izquierda de un mes de evolución, blando, fluctuante, límites mal definidos, de 5x4 cm de diámetro, afebril, sin cambios de coloración. Presentaba trismus y dolor a la palpación. Hace cinco meses había sido tratado por una osteomielitis frontoparietal izquierda con absceso subgaleal. Antecedentes mórbidos del paciente: alcohólico crónico y anemia en tratamiento. El paciente fue hospitalizado con tratamiento de Clocaxiclina endovenoso, coleccionándose en la región preauricular. Se realizó la biopsia dando como resultado osteomielitis de cóndilo mandibular. La osteomielitis presentada en el cóndilo mandibular pudo ser recidiva de la osteomielitis anterior o haber sido causada por la anemia. Sin embargo, la osteomielitis frontoparietal se presentó sin causa aparente, pudiendo relacionarla con la anemia que cursaba.
Osteomyelitis is defined as a progressive inflammation of the bone, which occurs most frequently in the long bones of the body. Its etiology is related to local and / or systemic factors that include anemia. Osteomyelitis resulting from sickle cell anemia results in the blood being more viscous producing a low blood flow leading to ischemic attack and bone necrosis. Patient presented with increased volume in the left preauricular region following one month of evolution, soft, fluctuating, ill-defined limits, 5x4 cm in diameter, afebrile, without discoloration. He had trismus, tenderness and had been admitted to the emergency room five months earlier, for osteomyelitis with subgaleal abscess. Patient`s background included anemia and treatment for chronic alcoholism. The patient was hospitalized with intravenous treatment of cloxacilline, resulting in increased preauricular volume with defined limits. Results following a biopsy showed condyle osteomyelitis. Osteomyelitis presented in the condyle may be the recurrence of osteomyelitis or may have been caused by the anemia. However, frontoparietal osteomyelitis has no apparent cause and could be associated with anemia.