ABSTRACT
Resumo Pacientes portadores de doença arterial obstrutiva periférica com isquemia crítica do membro associada a infecção de prótese vascular apresentam elevadas taxas morbimortalidade e alto risco de perda do membro. Apresentamos o caso de um paciente masculino de 76 anos com isquemia crítica do membro inferior esquerdo associada a infecção de prótese vascular femoropoplítea. Utilizamos abordagem híbrida para o tratamento com acesso cirúrgico das regiões inguinais e poplíteas, sendo a prótese vascular utilizada como acesso endovascular para recanalização direta da artéria femoral superficial devido a obstrução longa e extensa calcificação, que impediram as tentativas iniciais de tratamento endovascular. Após a recanalização endovascular, a prótese infectada foi retirada. O avanço das técnicas e materiais endovasculares em associação com a cirurgia aberta permitem novas soluções para pacientes quando os procedimentos habituais falham.
Abstract Patients with severe arterial obstructive disease and critical limb ischemia associated with vascular graft infection have elevated morbidity and mortality rates and are at high risk of limb loss. We present the case of a 76-year-old male patient with left lower limb critical ischemia and a femoropopliteal vascular graft infection. We used a hybrid treatment approach with an open surgical approach to the inguinal and popliteal regions and used the vascular prosthesis as endovascular access for direct recanalization of the superficial femoral artery, because the long occlusion and extensive calcification had frustrated initial attempts at endovascular treatment. After endovascular recanalization, the infected graft was removed. Used in conjunction with open surgery, advances in endovascular techniques and materials offer new solutions for patients when usual procedures fail.
Subject(s)
Humans , Aged , Prosthesis-Related Infections/surgery , Limb Salvage/methods , Blood Vessel Prosthesis/adverse effects , Endovascular Procedures/methods , Chronic Limb-Threatening Ischemia/surgeryABSTRACT
Objective:To explore whether MRI WARP sequence can provide clearer musculoskeletal images to guide the operation for patients with periprosthetic joint infection (PJI) by comparing MRI WARP sequence images with conventional sequence images.Methods:The data were analyzed retrospectively of 23 PJI patients who had been diagnosed and treated at Department of Orthopedics, The First Affiliated Hospital to Fujian Medical University from January 2020 to February 2021. They were 13 females and 10 males, with an average age of 62.8 years (from 32 to 88 years). According to the MRI sequences, they were divided into a WARP group ( n=14) subjected to MRI scanning by WARP sequence and a conventional group ( n=9) subjected to MRI scanning by conventional sequence. The gender, age, erythrocyte sedimentation rate (ESR) and C-reaction protein (CRP) were recorded for both groups. The signal-to-noise ratios were compared between the 2 sequences and 2 experts evaluated the clarity and surgical guidance of the images. Results:There was no significant difference in gender, age, CRP or ESR between the 2 groups, showing comparability ( P>0.05). The 2 experts showed consistency in evaluation of image sharpness and surgical guidance ( P<0.05). The WARP group was significantly better than the conventional group in image sharpness score [2.25(2.0, 2.6) versus 1.00 (0.5, 1.0)], surgical guidance score [2.00(1.5, 2.5) versus 0.50(0, 0.8)], and signal-to-noise ratio [47.28 (32.8, 74.3) versus 21.67(13.5, 31.4)] ( P<0.05). Conclusion:MRI WARP sequence can provide clearer musculoskeletal images than conventional MRI sequence to better guide the operation for PJI patients.
ABSTRACT
OBJECTIVE@#To investigate the therapeutic effects of vacuum sealing drainage (VSD) combined with antibiotics in treating acute periprosthetic joint infection (PJI).@*METHODS@#From March 2012 to December 2018, there were 11 patients with acute PJI underwent debridement, VSD, antibiotics and retention of implant, including 7 males and 4 females, with an average age of 72.5 years old (ranged, 58 to 88 years old). There were 8 hips and 3 knees. Three patients had sinus tract.@*RESULTS@#There were 2 patients with negative culture result and 9 patients with positive culture result, including 5 cases of methicillin sensitive staphylococcus aureus, 2 cases of methicillin-resistant staphylococcus aureus (MRSA), 2 cases of staphylococcus epidermidis. The mean follow up duration was 28 months (ranged from 8 to 52 months). One case of infection around hip prosthesis failed to be debrided. The time of debridement and replacement of the calcar joint was 84 days. Debridement was successful in 10 cases. At the latest follow up, Harris score of patients with successful debridement of hip periprosthetic infection ranged from 74 to 93, with an average score of 84.1;Knee Society scores of patients with periprosthetic infection were 84, 84, 89.@*CONCLUSION@#For acute infection around the prosthesis within 1 month after knee replacement and 6 weeks after hip replacement, and for bleeding around the prosthesis with acute infection caused by anticoagulant drugs, satisfactory results can be obtained by debridement, VSD and sensitive antibiotics.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Anti-Bacterial Agents , Arthroplasty, Replacement, Hip , Debridement , Drainage , Hip Prosthesis , Methicillin-Resistant Staphylococcus aureus , Negative-Pressure Wound Therapy , Prosthesis-Related Infections , Retrospective Studies , Treatment OutcomeABSTRACT
OBJETIVO: Avaliar o risco de contaminação operatória pela ventilação do motor de furadeiras elétricas (FE) durante a perfuração óssea em cirurgias ortopédicas. MATERIAIS E MÉTODOS: estudo experimental, laboratorial, randomizado analisou FE da prática clínica e FE novas (limpas e esterilizadas) submetidas à contaminação com esporos de Bacillus atrophaeus na concentração 84 x 10(6) UFC. O ar gerado pelo acionamento do motor da FE foi coletado e cultivado. RESULTADOS: Foram identificadas apenas duas culturas positivas para as FE da prática clínica, assim como uma cultura positiva para o Bacillus atrophaeus com crescimento de 1UFC (1,19 x 10(8)). CONCLUSÃO: nas condições do estudo, pode-se afirmar que o ar gerado pela ventilação do motor da FE não consiste em fonte de contaminação para o sítio cirúrgico.
OBJECTIVE: To evaluate the potential risk of surgical contamination by the venting port of ordinary electric drills (ED) employed in orthopaedic surgeries. MATERIALS AND METHODS: an experimental laboratory, randomized study was developed to analyze EDs in surgical practice and new cleaned and sterilized equipment, which were contaminated with Bacillus atrophaeus spores at a concentration of 84 X 10(6) UFC. The air generated by the engine of each drill was collected and cultivated on sterile agar plates. RESULTS: Positive culture was identified in two ED in surgical practice, as well as a positive culture to Bacillus atrophaeus with 1 CFU growth (1,19 X 10-8). CONCLUSION: In the conditions of the experiment, the airgenerated by the venting port of the ED's engine does not consist of a source of contamination for the surgical site.