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A multi‐disciplinary approach to the management of fungal osteomyelitis: Current concepts in post‐traumatic lower extremity reconstruction: A case report
Author(s) -
Cetrulo Curtis L.,
Barone Angelo A. Leto,
Jordan Kathleen,
Chang David S.,
Louie Kevin,
Buntic Rudolf F.,
Brooks Darrell
Publication year - 2012
Publication title -
microsurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.031
H-Index - 63
eISSN - 1098-2752
pISSN - 0738-1085
DOI - 10.1002/micr.20956
Subject(s) - medicine , osteomyelitis , distraction osteogenesis , surgery , debridement (dental) , amputation , soft tissue , salvage therapy , regimen , voriconazole , osteitis , free flap , calcaneus , tibia , antifungal , chemotherapy , distraction , dermatology , neuroscience , biology
Limb salvage in fungal osteomyelitis of the post‐traumatic lower extremity represents a difficult clinical problem requiring aggressive management. We report lower extremity salvage by radical bony debridement, free tissue transfer, distraction osteogenesis with bone‐docking, and a novel antifungal regimen in a clinical setting of infection with Scedosporium inflatum, historically requiring amputation in 100% of cases. We treated Scedosporium inflatum osteomyelitis of the tibia and calcaneus with radical debridement of infected bone, free partial medial rectus abdominis muscle flap coverage, transport distraction osteogenesis, and combination voriconazole/terbinafine chemotherapy, a novel antifungal regimen. We achieved successful control of the infection, limb salvage, and an excellent functional outcome through aggressive debridement of infected bone and soft tissue, elimination of dead space within the bony defect, the robust perfusion provided by the free flap, the hypervascular state induced by distraction osteogenesis, and the synergism of the novel antifungal regimen. © 2011 Wiley Periodicals, Inc. Microsurgery, 2012.