Gastrocnemius muscle flap with vancomycin/gentamicin-calcium
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A Study was conducted to investigate the clinical effect of gastrocnemius muscle flaps combined with vancomycin/gentamicin-calcium sulfate combined and autologous iliac bone graft in the phase I treatment of traumatic focal osteomyelitis (Cierny-Mader type III) after tibial plateau fracture surgery.

35 patients with localized osteomyelitis (Cierny-Mader type III) who met the inclusion criteria were followed up and treated. All patients were infected after undergoing internal fracture fixation surgery. Among them, 18 cases were plate-exposed, 14 cases were due to sinus tracts, 2 were due to skin necrosis, and 1 was bone-exposed. The follow-up indicators included Hospital for Special Surgery knee scores (HSS), the time of laying drainage pipe, bone healing time, infection control rate, and the incidence of nonunion and other complications.

Results:
--All patients were followed up for 24–60?months. None of them underwent amputation. For repairing soft tissue defects, 17 cases were covered with a muscle flap using the medial head of gastrocnemius alone, 15 cases were treated with the lateral head of gastrocnemius muscle, and 3 cases were covered with the combination of the two heads.
--Compared to the preoperative score, it was found that the average HSS improved at the 1-year and 2-year follow-up (54 vs. 86 vs. 87).

In conclusion, employing a gastrocnemius muscle flap in combination with vancomycin/gentamicin-calcium sulfate and autogenous iliac bone for phase I therapy of osteomyelitis (Cierny-Mader type III) after tibial plateau fracture surgery was an effective strategy. It can reduce treatment time, number of operations, patient suffering, bone healing time, postoperative exudation, and infection recurrence rate, as well as boost the healing bone's strength, in the main treatment of focal traumatic osteomyelitis.

Source: https://josr-online.biomedcentral.com/articles/10.1186/s13018-021-02496-1
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