Application of three-stage Masquelet technique for infective bone defects of foot and ankle / 中华创伤杂志

ABSTRACT

Objective To investigate the clinical efficacy of three-stage Masquelet technique in the treatment of infective bone defects of foot and ankle.Methods A retrospective case series study was conducted on the clinical data of 19 patients with infective bone defects of foot and ankle admitted to Zhongnan Hospital of Wuhan University from December 2014 to October 2017.There were 15 males and four females,aged 18-68 years [(39.6 ± 12.3)years].Among the patients,16 patients were infected with bacteria and three patients were infected with Mycobacterium tuberculosis.The infection involved humeral end,talus and surrounding joints in 14 patients,internal hemorrhoids in two patients,midfoot and interphalangeal joints in one patient,and humerus and metatarsophalangeal joints in two.The operation included three stagesthe first stage was thorough debridement,supplemented with negative pressure closed drainage (VSD) and continuous washing to clarify the pathogenic bacteria;the second stage was to fill the bone defect with targeted antibiotic bone cement to prevent or treat infection;in the third stage,after filling the antibiotic bone cement for 3 months with no sign of local wound infection,the bone cement was taken out,and the bone reconstruction operation was performed by means of internal fixation and bone grafting.The flap survival and wound healing were observed,and the time of fracture healing was recorded.The American Orthopaedic Foot and Ankle Society (AOFAS) score and the Visual Analogue Score (VAS) were used to evaluate the improvement of the function of the foot and ankle before operation and at the last follow-up,and the bone healing was evaluated according to the radiographic union scale in tibial (RUST) fractures.Results The patients were followed up for 9-12 months [(11.1 ±1.0) months].Two patients with soft tissue defects caused by preoperative infection and necrosis received posterior tibial artery perforator flap and anterolateral thigh flap repair in the second stage,and the flaps all survived.The postoperative bone healing time was 3 7 months [(3.5 ± 1.4)months].Nineteen patients underwent three-stage surgery,and the ankle and foot wound or sinus tract were all healed,with no infection recurrence during follow-up.At the last follow-up,the AOFAS score was improved significantly from preoperative (36.3 s-12.1) points to (71.4 ± 5.7) points (P ＜ 0.05).The VAS was decreased significantly from preoperative (5.3 ± 1.2) points to (1.4 ± 0.9) points (P ＜ 0.05).The RUST bone healing score at the last follow-up was 8-12 points [(10.2 ± 1.1) points].Conclusion In treating the infective bone defects of foot and ankle,the three-stage Masquelet technique can effectively control infection,facilitate wound healing,promote bone union,and improve foot and ankle function.