Aims Calcaneal osteomyelitis remains a difficult condition to treat with high rates of recurrence and below-knee amputation, particularly in the presence of severe soft-tissue destruction. This study assesses the outcomes of single-stage orthoplastic surgical treatment of calcaneal osteomyelitis with large soft-tissue defects. Methods A retrospective review was performed of all patients who underwent combined single-stage orthoplastic treatment of calcaneal osteomyelitis (01/2008 to 12/2022). Primary outcome measures were osteomyelitis recurrence and below-knee amputation (BKA). Secondary outcome measures included flap failure, operating time, complications, and length of stay. Results A total of 30 patients (14 female, 16 male; mean age 53.7 years (95% CI 48.0 to 59.5)) underwent combined orthoplastic surgical treatment for BACH "complex" calcaneal osteomyelitis with a median follow-up of 31 months (IQR 11.75 to 49.25). Of these, 19 received a local flap and 11 received a free flap. The most common causes were fracture-related infection (n = 12; 40%) and ulceration (n = 10; 33%); 21 patients (70%) had already undergone at least one operation elsewhere. Osteomyelitis was eradicated in 23 patients (77%). There were seven patients who developed recurrent osteomyelitis (23%), all in the local flap group. One patient required a BKA. Univariate analysis revealed that local flap reconstruction (OR 13.5 (95% CI 0.7 to 269.7); p = 0.029) and peripheral vascular disease (OR 16.5 (95% CI 1.35 to 203.1); p = 0.008) were associated with increased risk of recurrence. Free flap reconstruction took significantly longer intraoperatively than local flaps (mean 481 minutes (408 to 554) vs mean 168 minutes (119 to 216); p < 0.001), but without significant differences in length of stay or frequency of outpatient appointments. Conclusion In our study involving 30 patients, single-stage orthoplastic management was associated with 77% (n = 23) eradication of infection and only one amputation in this complex and comorbid patient group. Risk factors for failure were peripheral vascular disease and local flap reconstruction. While good outcomes can be achieved, this treatment requires high levels of inpatient and outpatient care.

中文翻译：

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具有大软组织缺损的复杂跟骨骨髓炎的单期骨形治疗。


目的 跟骨骨髓炎仍然是一种难以治疗的疾病，复发率高，膝下截肢，尤其是在存在严重软组织破坏的情况下。本研究评估了伴有大软组织缺损的跟骨骨髓炎的单期骨整形手术治疗的结果。方法 对所有接受跟骨骨髓炎联合单期骨科治疗的患者 （2008 年 1 月至 2022 年 12 月） 进行回顾性分析。主要结局指标是骨髓炎复发和膝下截肢 （BKA）。次要结局指标包括皮瓣失败、手术时间、并发症和住院时间。结果 共有 30 例患者 （14 例女性，16 例男性;平均年龄 53.7 岁 （95% CI 48.0 至 59.5））接受了 BACH “复杂” 跟骨骨髓炎的骨科联合手术治疗，中位随访时间为 31 个月 （IQR 11.75 至 49.25）。其中，19 人接受了本地皮瓣，11 人获得了自由皮瓣。最常见的原因是骨折相关感染 （n = 12; 40%） 和溃疡 （n = 10; 33%）;21 例患者 （70%） 已经在其他地方接受了至少一次手术。23 例患者 （77%） 根除骨髓炎。有 7 例患者发生复发性骨髓炎 （23%），均在局部皮瓣组中。1 例患者需要 BKA。单变量分析显示，局部皮瓣重建 （OR 13.5 （95% CI 0.7 - 269.7）;p = 0.029）和外周血管疾病 （OR 16.5 （95% CI 1.35 - 203.1）;p = 0.008 ）与复发风险增加相关。游离皮瓣重建术在术中花费的时间明显长于局部皮瓣（平均 481 分钟（408 至 554 分钟）与平均 168 分钟（119 至 216 分钟）;p < 0.001），但在住院时间或门诊预约频率方面没有显著差异。结论 在我们涉及 30 例患者的研究中，单阶段骨形管理与 77% （n = 23） 的感染根除相关，并且在这个复杂且共病的患者组中只有 1 例截肢。失败的危险因素是外周血管疾病和局部皮瓣重建。虽然可以取得良好的结果，但这种治疗需要高水平的住院和门诊护理。