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Papineau debridement, Ilizarov bone transport, and negative-pressure wound closure for septic bone defects of the tibia

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Ilizarov pioneered bone transport using a circular external fixator. Papineau described a staged technique for the treatment for infected pseudarthrosis of the long bones. This article presents a single-stage Papineau technique and Ilizarov bone transport, and postoperative negative-pressure wound dressing changes for septic bone defects of the tibia.

Materials and methods

We studied the files of seven patients (mean age, 32 years) with septic bone defects of the tibia treated with a Papineau technique and Ilizarov bone transport in a single stage, followed by postoperative negative-pressure wound dressing changes. All patients had septic pseudarthrosis and skin necrosis of the tibia. The technique included a single-stage extensive surgical debridement of necrotic bone, open bone grafting with cancellous bone autograft and bone transport, and postoperative negative-pressure wound dressing changes for wound closure. The mean time from the initial injury was 6 months (range, 4–8 months). The mean follow-up was 14 months (range, 10–17 months).

Results

All patients experienced successful wound healing at a mean of 29 days. Six patients experienced successful bone regeneration and union at the docking side at a mean of 6 months. One patient experienced delayed union at the docking site, which was treated with autologous cancellous bone grafting. Two patients experienced pin track infection, which was successfully treated with antibiotics and pin site dressing changes. All patients were able to return to their work and previous levels of activity, except one patient who had a stiff ankle joint and had to change his job. No patient experienced recurrence of infection, or fracture of the regenerated or transported bone segment until the period of this study.

Conclusion

The combined Papineau and Ilizarov bone transport technique with negative-pressure wound closure provides for successful eradication of the infection, reconstruction of the bone defect, and soft-tissue closure. A single-stage surgical treatment is feasible, without any complications.

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References

  1. Papineau LJ (1973) Excision-graft with deliberately delayed closing in chronic osteomyelitis. Nouv Presse Med 2(41):2753–2755

    CAS  PubMed  Google Scholar 

  2. Papineau LJ, Alfageme A, Dalcourt JP, Pilon L (1979) Chronic osteomyelitis: open excision and grafting after saucerization (author’s transl). Int Orthop 3(3):165–176

    CAS  PubMed  Google Scholar 

  3. Ilizarov GA (1971) Basic principles of transosseous compression and distraction osteosynthesis. Ortop Travmatol Protez 32(11):7–15

    CAS  PubMed  Google Scholar 

  4. Ilizarov GA, Kaplunov AG, Degtiarev VE, Lediaev VI (1972) Treatment of pseudarthroses and ununited fractures, complicated by purulent infection, by the method of compression-distraction osteosynthesis. Ortop Travmatol Protez 33(11):10–14

    CAS  PubMed  Google Scholar 

  5. Wang XG, Wang W, Wang XY, Lu L, Wang GQ, Ma QS, Su GY (2010) One stage treatment of infected tibial defects combined with skin defects with Ilizarov technique. Zhongguo gu shang China J Orthop Traumatol 23(6):422–425

    Google Scholar 

  6. Courvoisier A, Sailhan F, Thevenin-Lemoine C, Vialle R, Damsin J (2009) Congenital tibial deficiencies: treatment using the Ilizarov’s external fixator. Orthop Traumatol Surg Res 95(6):431–436

    Article  CAS  PubMed  Google Scholar 

  7. Ozturkmen Y, Karamehmetoglu M, Karadeniz H, Azboy I, Caniklioglu M (2009) Acute treatment of segmental tibial fractures with the Ilizarov method. Injury 40(3):321–326

    Article  PubMed  Google Scholar 

  8. Emami A, Mjoberg B, Larsson S (1995) Infected tibial nonunion. good results after open cancellous bone grafting in 37 cases. Acta Orthop 66(5):447–451

    Article  CAS  Google Scholar 

  9. Sachs BL, Shaffer JW (1984) A staged Papineau protocol for chronic osteomyelitis. Clin Orthop Relat Res 184:256–263

    PubMed  Google Scholar 

  10. Archdeacon MT, Messerschmitt P (2006) Modern Papineau technique with vacuum-assisted closure. J Orthop Trauma 20(2):134–137

    Article  PubMed  Google Scholar 

  11. Polyzois VD, Galanakos S, Zgonis T, Papakostas I, Macheras G (2010) Combined distraction osteogenesis and Papineau technique for an open fracture management of the distal lower extremity. Clin Podiatr Med Surg 27(3):463–467

    Article  PubMed  Google Scholar 

  12. Cierny G 3rd, Mader JT, Penninck JJ (2003) A clinical staging system for adult osteomyelitis. Clin Orthop Relat Res 414:7–24

    Article  PubMed  Google Scholar 

  13. Gustilo RB, Anderson JT (1976) Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am 58(4):453–458

    CAS  PubMed  Google Scholar 

  14. Gustilo RB, Mendoza RM, Williams DN (1984) Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 24(8):742–746

    Article  CAS  PubMed  Google Scholar 

  15. Esterhai JL Jr, Sennett B, Gelb H, Heppenstall RB, Brighton CT, Osterman AL, LaRossa D, Gelman H, Goldstein G (1990) Treatment of chronic osteomyelitis complicating nonunion and segmental defects of the tibia with open cancellous bone graft, posterolateral bone graft, and soft-tissue transfer. J Trauma 30(1):49–54

    Article  PubMed  Google Scholar 

  16. Green SA (1992) Ilizarov method. Clin Orthop Relat Res 280:2–6

    PubMed  Google Scholar 

  17. Delloye C, Delefortrie G, Coutelier L, Vincent A (1990) Bone regenerate formation in cortical bone during distraction lengthening. an experimental study. Clin Orthop Relat Res 250:34–42

    PubMed  Google Scholar 

  18. Frierson M, Ibrahim K, Boles M, Bote H, Ganey T (1994) Distraction osteogenesis. a comparison of corticotomy techniques. Clin Orthop Relat Res 301:19–24

    PubMed  Google Scholar 

  19. Canadell J, Forriol F, Cara JA (1994) Removal of metaphyseal bone tumours with preservation of the epiphysis Physeal distraction before excision. J Bone Joint Surg Br 76(1):127–132

    CAS  PubMed  Google Scholar 

  20. Cattaneo R, Catagni MA, Guerreschi F (1993) Applications of the Ilizarov method in the humerus Lengthenings and nonunions. Hand Clin 9(4):729–739

    CAS  PubMed  Google Scholar 

  21. Green SA, Jackson JM, Wall DM, Marinow H, Ishkanian J (1992) Management of segmental defects by the Ilizarov intercalary bone transport method. Clin Orthop Relat Res 280:136–142

    PubMed  Google Scholar 

  22. Cierny G 3rd, Zorn KE (1994) Segmental tibial defects. comparing conventional and Ilizarov methodologies. Clin Orthop Relat Res 301:118–123

    PubMed  Google Scholar 

  23. Herscovici D Jr, Sanders RW, Scaduto JM, Infante A, DiPasquale T (2003) Vacuum-assisted wound closure (VAC therapy) for the management of patients with high-energy soft tissue injuries. J Orthop Trauma 17(10):683–688

    Article  PubMed  Google Scholar 

  24. Argenta LC, Morykwas MJ, Marks MW, DeFranzo AJ, Molnar JA, David LR (2006) Vacuum-assisted closure: state of clinic art. Plastic Recon Surg 117(7 Suppl):127S–142S

    Article  CAS  Google Scholar 

  25. Bucalo B, Eaglstein WH, Falanga V (1993) Inhibition of cell proliferation by chronic wound fluid. wound repair and regeneration: official publication of the wound healing society [and] the European tissue repair society, 1(3): 181–186

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Conflict of interest

None of the authors have any financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work.

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Authors and Affiliations

  1. First Department of Orthopaedics, Athens University Medical School, Attikon University Hospital, 41 Ventouri Street, 15562, Holargos, Athens, Greece

    Andreas F. Mavrogenis

  2. Third Department of Orthopaedics, Athens University Medical School, KAT Hospital, 41 Ventouri Street, 15562, Holargos, Athens, Greece

    Orestis Karargyris, Vasilios D. Polyzois, Panayiotis Karabinas & Spyros G. Pneumaticos

Authors
  1. Orestis Karargyris
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  2. Vasilios D. Polyzois
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  3. Panayiotis Karabinas
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  4. Andreas F. Mavrogenis
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  5. Spyros G. Pneumaticos
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Corresponding author

Correspondence to Spyros G. Pneumaticos.

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Karargyris, O., Polyzois, V.D., Karabinas, P. et al. Papineau debridement, Ilizarov bone transport, and negative-pressure wound closure for septic bone defects of the tibia. Eur J Orthop Surg Traumatol 24, 1013–1017 (2014). https://doi.org/10.1007/s00590-013-1279-x

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  • DOI: https://doi.org/10.1007/s00590-013-1279-x

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