The Concept of Treatment for Surgical Infection in the Hindfoot
Background: Chronic osteomyelitis of the calcaneus (OC) and open infected calcaneal fractures, especially when complicated by infected soft tissue defects, present significant surgical challenges. Accepted recommendations for the surgical treatment of this pathology are yet to be established. Method...
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2024-04-01
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| Series: | Foot & Ankle Orthopaedics |
| Online Access: | https://doi.org/10.1177/24730114241241058 |
| _version_ | 1797208382254350336 |
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| author | Chingiz Alizade MD, PhD Huseyn Aliyev MD, PhD Farhad Alizada |
| author_facet | Chingiz Alizade MD, PhD Huseyn Aliyev MD, PhD Farhad Alizada |
| author_sort | Chingiz Alizade MD, PhD |
| collection | DOAJ |
| description | Background: Chronic osteomyelitis of the calcaneus (OC) and open infected calcaneal fractures, especially when complicated by infected soft tissue defects, present significant surgical challenges. Accepted recommendations for the surgical treatment of this pathology are yet to be established. Methods: Drawing from our experience and the consensus among experts, we have developed a concept for selecting optimal, well-known surgical approaches based on the specific pathologic presentation. This concept distinguishes 4 main forms of hindfoot infection: infected wounds, open infected fractures, OC, and their mixed forms. Patients with conditions that could confound the treatment outcomes, such as diabetes mellitus and neurotrophic diseases, were excluded from this analysis. We present a retrospective analysis of the treatment outcomes for 44 patients (4 women and 40 men) treated between 2009 and 2022 using some refined surgical techniques. Treatment success was evaluated based on the absence of disease recurrence within a 2-year follow-up, the avoidance of below-knee amputations, and the restoration of weightbearing function. Results: The treatment results were considered through the prism of our proposed concept and according to the Cierny-Mader classification. There were 4 instances of disease recurrence, necessitating 6 additional surgeries, 2 of which (4.5% of the patient cohort) resulted in amputations. In the remaining cases, we were able to restore weightbearing function and eliminate the infection through reconstructive surgeries, employing skin grafts when necessary. Conclusion: Surgical infections of the hindfoot area remain a significant challenge. The strategic concept we propose for surgical decision making, tailored to the specific pathology, represents a potential advancement in addressing this challenge. This framework could provide valuable guidance for orthopaedic surgeons in their clinical decision-making process. Level of Evidence: Level IV, case series. |
| first_indexed | 2024-04-24T09:37:55Z |
| format | Article |
| id | doaj.art-afebaf76d8404fa5b86e022bb0c076f2 |
| institution | Directory Open Access Journal |
| issn | 2473-0114 |
| language | English |
| last_indexed | 2024-04-24T09:37:55Z |
| publishDate | 2024-04-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Foot & Ankle Orthopaedics |
| spelling | doaj.art-afebaf76d8404fa5b86e022bb0c076f22024-04-15T09:04:35ZengSAGE PublishingFoot & Ankle Orthopaedics2473-01142024-04-01910.1177/24730114241241058The Concept of Treatment for Surgical Infection in the HindfootChingiz Alizade MD, PhD0Huseyn Aliyev MD, PhD1Farhad Alizada2HB Guven Clinic Baku, Baku, AzerbaijanAzerbaijan Scientific Research Institute of Traumatology and Orthopedics, Baku, AzerbaijanKlinikum am Gesundbrunnen (SLK-Kliniken Heilbronn GmbH), Am Gesundbrunnen 20-26, 74078 HeilbronnBackground: Chronic osteomyelitis of the calcaneus (OC) and open infected calcaneal fractures, especially when complicated by infected soft tissue defects, present significant surgical challenges. Accepted recommendations for the surgical treatment of this pathology are yet to be established. Methods: Drawing from our experience and the consensus among experts, we have developed a concept for selecting optimal, well-known surgical approaches based on the specific pathologic presentation. This concept distinguishes 4 main forms of hindfoot infection: infected wounds, open infected fractures, OC, and their mixed forms. Patients with conditions that could confound the treatment outcomes, such as diabetes mellitus and neurotrophic diseases, were excluded from this analysis. We present a retrospective analysis of the treatment outcomes for 44 patients (4 women and 40 men) treated between 2009 and 2022 using some refined surgical techniques. Treatment success was evaluated based on the absence of disease recurrence within a 2-year follow-up, the avoidance of below-knee amputations, and the restoration of weightbearing function. Results: The treatment results were considered through the prism of our proposed concept and according to the Cierny-Mader classification. There were 4 instances of disease recurrence, necessitating 6 additional surgeries, 2 of which (4.5% of the patient cohort) resulted in amputations. In the remaining cases, we were able to restore weightbearing function and eliminate the infection through reconstructive surgeries, employing skin grafts when necessary. Conclusion: Surgical infections of the hindfoot area remain a significant challenge. The strategic concept we propose for surgical decision making, tailored to the specific pathology, represents a potential advancement in addressing this challenge. This framework could provide valuable guidance for orthopaedic surgeons in their clinical decision-making process. Level of Evidence: Level IV, case series.https://doi.org/10.1177/24730114241241058 |
| spellingShingle | Chingiz Alizade MD, PhD Huseyn Aliyev MD, PhD Farhad Alizada The Concept of Treatment for Surgical Infection in the Hindfoot Foot & Ankle Orthopaedics |
| title | The Concept of Treatment for Surgical Infection in the Hindfoot |
| title_full | The Concept of Treatment for Surgical Infection in the Hindfoot |
| title_fullStr | The Concept of Treatment for Surgical Infection in the Hindfoot |
| title_full_unstemmed | The Concept of Treatment for Surgical Infection in the Hindfoot |
| title_short | The Concept of Treatment for Surgical Infection in the Hindfoot |
| title_sort | concept of treatment for surgical infection in the hindfoot |
| url | https://doi.org/10.1177/24730114241241058 |
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