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. 2016 Jun;4(3):259-63.

Epithelialization Over a Scaffold of Antibiotic-Impregnated PMMA Beads: A Salvage Technique for Open Tibial Fractures with Bone and Soft Tissue Loss When all Else Fails

Karim Z Masrouha  1 , Youssef El-Bitar  1 , Marc Najjar  1 , Said Saghieh  1
Affiliations

Epithelialization Over a Scaffold of Antibiotic-Impregnated PMMA Beads: A Salvage Technique for Open Tibial Fractures with Bone and Soft Tissue Loss When all Else Fails

Karim Z Masrouha et al. Arch Bone Jt Surg. 2016 Jun.

Abstract

The management of soft tissue defects in tibial fractures is essential for limb preservation. Current techniques are not without complications and may lead to poor functional outcomes. A salvage method is described using three illustrative cases whereby a combination of flaps and antibiotic-impregnated polymethylmethacrylate beads are employed to fill the bony defect, fight the infection, and provide a surface for epithelial regeneration and secondary wound closure. This was performed after the partial failure of all other options. All patients were fully ambulatory with no clinical, radiographic or laboratory sign of infection at their most recent follow-up. Although our findings are encouraging, this is the first report of epithelialization of the skin on a polymethylmethacrylate scaffold. Further studies investigating the use of this technique are warranted.

Keywords: Infection; Open tibial fracture; Polymethylmethacrylate; Soft tissue defect.

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Figures

Figure 1a
Figure 1a
Clinical image of the leg of Case 1 demonstrating the proximal soft tissue defect filled with cement pellets (white arrow) after reconstruction with a rotational flap and split thickness skin graft.
Figure 1b
Figure 1b
A plain radiograph of the same patient showing the anterior bony defect filled with cement pellets.
Figure 2
Figure 2
Clinical image showing the final result with secondary skin closure.
Figure 3
Figure 3
A plain radiograph showing bone healing after substituting the pellets with bone graft.
Figure 4
Figure 4
A plain radiograph showing distal tibial shaft bone defect along with the defect filled with cement pellets.
Figure 5
Figure 5
Clinical image showing the final result with closure of the proximal wound.
Figure 6
Figure 6
a, b, c. Intraoperative image showing the open lateral foot wounds which were filled with cement pellets.
Figure 7
Figure 7
Clinical image after removal of the fixator and secondary closure of the foot wounds.
See this image and copyright information in PMC

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