(LBA-004) Surgical Treatment for Reconstruction and Innovative Deformity Elimination
Saturday, May 18, 2024
Introduction: A way to reduce amputation of acute and chronic osteomyelitis
Methods:
The development of a technique to percutaneously deliver flowable sulfate gentamicin bone graft to kill all bacteria in the bone and does not require incision or large bone resection. A retrospective review of the cases showed we were able to successfully treat the metatarsals, cuneiforms, cuboid, talus, calcaneus, tibia, and fibula. In addition, there were injections into the 1st digit proximal and distal phalanx and proximal phalanx of the lesser digits with successful outcomes. The technique required a minimum of two injection ports in each bone. We are able to get a bone biopsy with the port in the area of infection concern. The second port allowed venting that prevented overfilling the bone or leaking into the venous system. This technique also allows for applying some pressure from both ports to push the flowable into the edges. The product is semi-radioopaque so it can be visualized filling the bone.
Results: We were able to do 100 cases where the percutaneous technique was able to reduce the need for or minimize amputation. While multiple of these patients had been given the option of BKA, we were able to save the entire limb. Of the 100 cases reviewed, we had 3 patients who needed further amputation. One of which was due to patient noncompliance.
Discussion: As wound care physicians we are always looking for better ways to prevent or reduce amputation. There are two ways to treat acute and chronic osteomyelitis. The first is long-term antibiotics. The second is clean margin resection(amputation). This new technique allows a minimally invasive technique to deliver flowable antibiotic-based sulfate bone graft intramedullary. This allows for targeted treatment in the bone for 30 days. The gentamycin concentration is above all MIC's so it will kill any bacteria it comes in contact with for 30 days. As a bone void filler, it strengthens the bone as a secondary benefit. It appears to be a new and effective way to treat osteomyelitis. It will require prospective studies to verify the early results.