Vacuum sealing drainage combined with eggshell-like debridement antibiotic-loaded calcium sulphate for calcaneal osteomyelitis

Abstract

Background: To compare the clinical efficacy of vacuum sealing drainage, eggshell-like debridement combined with antibiotic calcium sulphate implantation and conventional debridement combined with antibiotic calcium sulphate implantation in the treatment of calcaneal osteomyelitis.

Methods: Sixty-six patients with calcaneal osteomyelitis who were treated in our department between January 2017 and August 2021 were included in this study. Thirty-one patients underwent VSD and eggshell-like debridement combined with antibiotic calcium sulphate implantation. Thirty-five patients underwent conventional debridement combined with antibiotic calcium sulphate implantation. The inflammatory markers, operation time, wound healing time, hospital stay, full weight bearing time after operation, recurrence rate of infection, complications, and American Orthopedic Foot and Ankle Society (AOFAS) scores were compared between the two groups.

Results: The operation time and full weight bearing time after operation of observation group were longer than that of control group. Compared with preoperative results, WBC, ESR, CRP and PCT in both groups were significantly decreased at 14 days after operation, and there was no statistical significance between the two groups. The wound healing time and hospital stay in the observation group were shorter than those in the control group (P < 0.05). There were four patients with aseptic exudation in the observation group and ten patients with aseptic exudation in the control group, and the wounds healed well after multiple dressing changes. Seven patients in the observation group underwent secondary bone grafting due to bone defects, and four patients in the control group received secondary bone grafting due to bone defects. In the observation group, three patients received debridement combined with antibiotic calcium sulphate implantation again due to recurrent infection, compared with seven patients in the control group. One year after operation, the observation group had a better AOFAS scores than the control group, especially in terms of foot function (P < 0.05).

Conclusion: Compared with conventional debridement and antibiotic calcium sulphate implantation, VSD and eggshell-like debridement combined with antibiotic calcium sulphate implantation in the treatment of calcaneal osteomyelitis can shorten the wound healing and hospital stay of patients, reduce postoperative aseptic exudation complications and infection recurrence rate, and better preserve the foot function, which is a simple and effective method.

Keywords: Antibiotic-loaded calcium sulphate; Calcaneal osteomyelitis; Eggshell-like debridement; Vacuum sealing drainage.

Fig. 1

Preparation of antibiotic-loaded calcium sulphate pellets. a Paste calcium sulphate mixed with antibiotics is placed on a mould and left to dry and solidify. b Remove the solidified calcium sulphate pellets and set aside in a container

Fig. 2

A 58-year-old man. Diagnosed with right calcaneal osteomyelitis. a Preoperative gross picture showed swelling and sinus formation in the calcaneal of the right foot. b Preoperative X-ray of the right calcaneal showed bone defect and sclerosis of the infected lesion. c Intraoperative methylene blue stained lesion is revealed. d One month after the operation, X-ray showed the implantation of calcium sulphate particles in the calcaneal bone. e Three months after operation, X-ray showed partial degradation of calcium sulphate; f One year after operation, X-ray showed new bone formation at the site of the defect

Fig. 3

A 61-year-old man. Diagnosed with left calcaneal osteomyelitis. a Preoperative gross picture showed swelling and sinus formation in the calcaneal of the left foot. b Preoperative CT of the foot shows a local bone defect with multiple residual nail tracts. c Intraoperative methylene blue stained lesion is revealed. d One month after operation, X-ray showed the implantation of calcium sulphate particles in the calcaneal bone. e Three months after operation, X-ray showed calcium sulphate degradation, new bone formation and uneven increase in bone density. f Nine months after operation, the X-ray showed gradual uniformity of bone density and healing of the bone defect