A multi-institutional analysis of sternoclavicular joint coverage following osteomyelitis
Background Sternoclavicular joint (SCJ) osteomyelitis is a rare pathology requiring urgent intervention. Several operative approaches have been described with conflicting reports. Here, we present a multi-institutional study utilizing multiple surgical pathways for SCJ reconstruction. Me...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Thieme Medical Publishers, Inc.
2020-09-01
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| Series: | Archives of Plastic Surgery |
| Subjects: | |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.5999/aps.2020.00717 |
| _version_ | 1828109660459106304 |
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| author | Sammy Othman Omar Elfanagely Saïd C. Azoury Geoffrey M. Kozak Jessica Cunning Arturo J. Rios-Diaz Prashanth Palvannan Patrick Greaney Matthew P. Jenkins Doraid Jarrar Stephen J. Kovach John P. Fischer |
| author_facet | Sammy Othman Omar Elfanagely Saïd C. Azoury Geoffrey M. Kozak Jessica Cunning Arturo J. Rios-Diaz Prashanth Palvannan Patrick Greaney Matthew P. Jenkins Doraid Jarrar Stephen J. Kovach John P. Fischer |
| author_sort | Sammy Othman |
| collection | DOAJ |
| description | Background Sternoclavicular joint (SCJ) osteomyelitis is a rare pathology requiring urgent intervention. Several operative approaches have been described with conflicting reports. Here, we present a multi-institutional study utilizing multiple surgical pathways for SCJ reconstruction.
Methods A multi-institutional retrospective cohort study was conducted to identify patients who underwent surgical repair for sternoclavicular osteomyelitis between 2008 and 2019. Patients were stratified according to reconstruction approach: single-stage reconstruction with advancement flap and delayed-reconstruction with flap following initial debridement. Demographics, operative approach, type of reconstruction, and postoperative outcomes were analyzed.
Results Thirty-two patients were identified. Mean patient age was 56.2±13.8 years and 68.8% were male. The average body mass index (BMI) was 30.0±8.8 kg/m2. The most common infection etiologies were intravenous drug use and bacteremia (both 25%). Fourteen patients (43.8%) underwent one-stage reconstruction and 18 (56.2%) underwent delayed twostaged reconstruction. Both single and delayed-stage groups had comparable rates of reinfection (7.1% vs. 11.1%, respectively), surgical site complications (21.4% vs. 27.8%), readmissions (7.1% vs. 16.6%), and reoperations (7.1% vs. 5.6%; all P>0.05). The single-stage reconstruction group had a significantly lower BMI (26.2±5.7 kg/m2 vs. 32.9±9.1 kg/m2; P<0.05) and trended towards shorter hospital length of stay (11.3 days vs. 17.9 days; P=0.01).
Conclusions Both single and delayed-stage approaches are appropriate methods with comparable outcomes for reconstruction for SCJ osteomyelitis. When clinically indicated, a single-stage reconstruction approach may be preferable in order to avoid a second operation as associated with the delayed phase, and possibly shortening total hospital length of stay. |
| first_indexed | 2024-04-11T11:06:40Z |
| format | Article |
| id | doaj.art-b68846fdccb44946a904669beb4085e1 |
| institution | Directory Open Access Journal |
| issn | 2234-6163 2234-6171 |
| language | English |
| last_indexed | 2024-04-11T11:06:40Z |
| publishDate | 2020-09-01 |
| publisher | Thieme Medical Publishers, Inc. |
| record_format | Article |
| series | Archives of Plastic Surgery |
| spelling | doaj.art-b68846fdccb44946a904669beb4085e12022-12-22T04:28:19ZengThieme Medical Publishers, Inc.Archives of Plastic Surgery2234-61632234-61712020-09-01470546046610.5999/aps.2020.007173772A multi-institutional analysis of sternoclavicular joint coverage following osteomyelitisSammy Othman0Omar Elfanagely1Saïd C. Azoury2Geoffrey M. Kozak3Jessica Cunning4Arturo J. Rios-Diaz5Prashanth Palvannan6Patrick Greaney7Matthew P. Jenkins8Doraid Jarrar9Stephen J. Kovach10John P. Fischer11Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USADivision of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USADivision of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USADivision of Plastic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USADivision of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USADivision of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USADivision of Plastic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USADivision of Plastic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USADivision of Plastic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USADivision of Thoracic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USADivision of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USADivision of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USABackground Sternoclavicular joint (SCJ) osteomyelitis is a rare pathology requiring urgent intervention. Several operative approaches have been described with conflicting reports. Here, we present a multi-institutional study utilizing multiple surgical pathways for SCJ reconstruction. Methods A multi-institutional retrospective cohort study was conducted to identify patients who underwent surgical repair for sternoclavicular osteomyelitis between 2008 and 2019. Patients were stratified according to reconstruction approach: single-stage reconstruction with advancement flap and delayed-reconstruction with flap following initial debridement. Demographics, operative approach, type of reconstruction, and postoperative outcomes were analyzed. Results Thirty-two patients were identified. Mean patient age was 56.2±13.8 years and 68.8% were male. The average body mass index (BMI) was 30.0±8.8 kg/m2. The most common infection etiologies were intravenous drug use and bacteremia (both 25%). Fourteen patients (43.8%) underwent one-stage reconstruction and 18 (56.2%) underwent delayed twostaged reconstruction. Both single and delayed-stage groups had comparable rates of reinfection (7.1% vs. 11.1%, respectively), surgical site complications (21.4% vs. 27.8%), readmissions (7.1% vs. 16.6%), and reoperations (7.1% vs. 5.6%; all P>0.05). The single-stage reconstruction group had a significantly lower BMI (26.2±5.7 kg/m2 vs. 32.9±9.1 kg/m2; P<0.05) and trended towards shorter hospital length of stay (11.3 days vs. 17.9 days; P=0.01). Conclusions Both single and delayed-stage approaches are appropriate methods with comparable outcomes for reconstruction for SCJ osteomyelitis. When clinically indicated, a single-stage reconstruction approach may be preferable in order to avoid a second operation as associated with the delayed phase, and possibly shortening total hospital length of stay.http://www.thieme-connect.de/DOI/DOI?10.5999/aps.2020.00717notesosteomyelitissurgery, plasticreconstructive surgeryclavicle |
| spellingShingle | Sammy Othman Omar Elfanagely Saïd C. Azoury Geoffrey M. Kozak Jessica Cunning Arturo J. Rios-Diaz Prashanth Palvannan Patrick Greaney Matthew P. Jenkins Doraid Jarrar Stephen J. Kovach John P. Fischer A multi-institutional analysis of sternoclavicular joint coverage following osteomyelitis Archives of Plastic Surgery notes osteomyelitis surgery, plastic reconstructive surgery clavicle |
| title | A multi-institutional analysis of sternoclavicular joint coverage following osteomyelitis |
| title_full | A multi-institutional analysis of sternoclavicular joint coverage following osteomyelitis |
| title_fullStr | A multi-institutional analysis of sternoclavicular joint coverage following osteomyelitis |
| title_full_unstemmed | A multi-institutional analysis of sternoclavicular joint coverage following osteomyelitis |
| title_short | A multi-institutional analysis of sternoclavicular joint coverage following osteomyelitis |
| title_sort | multi institutional analysis of sternoclavicular joint coverage following osteomyelitis |
| topic | notes osteomyelitis surgery, plastic reconstructive surgery clavicle |
| url | http://www.thieme-connect.de/DOI/DOI?10.5999/aps.2020.00717 |
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