title: Two stage management of Cierny-Mader type IV chronic osteomyelitis of the long bones.
abstract: BACKGROUND
  Cierny-Mader (C-M) type IV chronic osteomyelitis represents a complex clinical challenge with permeation of extensive bone and soft tissue involvement. Aggressive debridement through viable tissue margin includes en bloc resection improves the odds of eradication of infection, which creates large bone and soft tissue loss in treating this type of osteomyelitis. The potentially large defects increase reconstruction problems with traditional reconstruction technique. The newly staged induced membrane technique presents length-independent, potential as an alternative reconstruction method for segmental bone defects due to type IV chronic osteomyelitis. The purpose of this study was to assess the result and related factors of C-M type IV chronic osteomyelitis treated with staged methods of aggressive debridement and induced membrane technique.
  
  
  METHODS
  From January 2012 to January 2014, 36 consecutive adult patients of C-M type IV chronic osteomyelitis were treated by this staged method in our clinical center with a minimum of 2-years follow-up. The clinical and imaging results were retrospectively analyzed.
  
  
  RESULTS
  Five patients had a second debridement and eight needed a local flap transfer to cover the wound in the first stage. Patients formed a mean of 5.5cm (range: 2-10.9) segmental bone defect; Sixteen patients had autograft and twenty had autograft mixed allograft in the second stage. The mean follow-up time was 29.5 months (range: 24-45). No patients required amputation. Bone union was achieved in all patients. Clinical eradication of osteomyelitis was achieved in 35 (97%) patients, 35 (97%) patients were able to walk independently, and 31patients (86%) returned to work. Patients returned to a mean of 82% (46.3%-100%) lower extremity function. Bone union time was not dependent on the length of bone defect, but associated with the infection site (p=0.005) and age (p=0.005).
  
  
  CONCLUSIONS
  Staged methods of aggressive debridement and induced membrane technique seems to be a simple, reliable and effective for the treatment of C-M type IV chronic osteomyelitis. Advanced age and poor soft tissue envelope may have adverse affects and are relative contraindications. The combined assessment and management of such patients with a plastic surgeon are advocated.
authors.affiliation: National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, People's Republic of China. Electronic address: 408394817@qq.com.
authors.forename: Hongri
authors.initials: H
authors.lastname: Wu
authors.affiliation: National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, People's Republic of China. Electronic address: shenjie_0907@163.com.
authors.forename: Jie
authors.initials: J
authors.lastname: Shen
authors.affiliation: National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, People's Republic of China. Electronic address: 525737727@qq.com.
authors.forename: Xin
authors.initials: X
authors.lastname: Yu
authors.affiliation: National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, People's Republic of China. Electronic address: fjj_4239@163.com.
authors.forename: Jingshu
authors.initials: J
authors.lastname: Fu
authors.affiliation: National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, People's Republic of China. Electronic address: 271485355@qq.com.
authors.forename: Shengpeng
authors.initials: S
authors.lastname: Yu
authors.affiliation: National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, People's Republic of China. Electronic address: sumersun07@163.com.
authors.forename: Dong
authors.initials: D
authors.lastname: Sun
authors.affiliation: National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, People's Republic of China. Electronic address: xiezhao54981@163.com.
authors.forename: Zhao
authors.initials: Z
authors.lastname: Xie
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D016025:Bone Transplantation / Q000379:methods*; D002681:China; D002908:Chronic Disease; D003646:Debridement / Q000379:methods*; D016267:External Fixators; D005260:Female; D005264:Femoral Fractures / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Bone defect; Bone infection; Induced membrane technique; Osteomyelitis