Is It Effective to Receive Free Flap Surgery for Lower Limb Osteomyelitis-A RetrospectiveStudy from a Single Institution Over 10 Years

探討自由皮瓣手術對下肢骨髓炎的治療成效－單一醫學中心十年的回顧性研究

Weng-Kit Sou(蘇永傑) ； Cherng-Kang Perng(彭成康) ； Hsu Ma(馬旭) ； Chin-Hsun Lin(林之勛)

《臺灣整形外科醫學會雜誌》 31卷4期 (2022/12) Pp. 258-270

摘要

Background: The treatment of lower limb osteomyelitis is challenging. The standard treatment is an antibiotic regimen and removal of necrotic bone tissues through debridement and sequestrectomy. Wounds can then be reconstructed with either local or free well-vascularised tissue, eliminating the need for major amputation. Thus, free flap surgery has been identified as a surgical option for the treatment of lower limb osteomyelitis. Aims and Objectives: The objective of this study was to determine the efficacyand requirement of free flap surgery in osteomyelitis patients. Methods: To explore the benefits of free flap surgery in patients with osteomyelitis, we conducted a retrospective study that explored the incidence of major amputation and overall survival rate. Results: Our study included 103 patients with osteomyelitis of the lower limb who underwent either local or free flap reconstruction after debridement and removal of necrotic bone tissue. There were 49 patients in the free flap group and 54 patients in the non-free flap group. All wounds were located distal to the knee. The most commonly used free flap was the anterior lateral thigh (ALT, 33/49, 67.3%). Patients in the non-free flap group had a higher mean age and higher incidence of comorbidities than those in the free flap group. Patients in the free flap group had longer hospital stays and antibiotic treatment duration but significantly lower major amputation rates than patients in the non-free flap group (odds ratio, 10.031; 95% confidence interval, 1.166-86.309, p =.036). However, in patients with a Charlson Comorbidity Index (CCI) score lower than 4, the free flap does not reduce the risk of major amputation. Conclusions: These findings suggest that free flap surgery could not play a role in decreasing major amputation rates in patients with lower extremity osteomyelitis, especially in patients with CCI score lower than 4.

關鍵字

major amputation ； free flaps ； lower extremity osteomyelitis ； reconstructive surgery

並列摘要

背景：下肢骨髓炎的治療非常具有挑戰性。目前的標準治療是使用抗生素和透過清創或死骨切除手術清除壞死的骨組織。手術後的傷口重建可以使用血液循環良好的局部或游離皮瓣，病患無需接受截肢手術以達到治療效果。因此，游離皮瓣手術已成為治療下肢骨髓炎的手術方案之一。目的及目標：本研究的目的是探討下肢骨髓炎患者接受游離皮瓣手術的必要性和成效。材料及方法：這是一個回顧性的研究，研究方式是把骨髓炎患者分成兩組：接受游離皮瓣手術的病患和沒有接受游離皮瓣手術的病患。比較兩組病患患肢的截肢率和總生存率，以評估游離皮瓣手術的成效。結果：我們的研究納入了103名下肢骨髓炎患者，部份病患在清創或死骨切除術後接受了游離皮瓣手術。其中接受游離皮瓣手術的病患有49名，沒有接受游離皮瓣手術的病患有54名。我們發現所有病患的傷口缺損位置都是在膝蓋以下。最常被使用的游離皮瓣是大腿前外側皮瓣（佔67.3%，33/49）。沒有接受游離皮瓣組患者的平均年齡和共病症都高於游離皮瓣組。與沒有接受游離皮瓣組相比，游離皮瓣組患者的住院時間和接受抗生素治療持續時間更長，但患肢截肢的比例顯著降低（OR, 10.031; 95% CI,1.166-86.309, p =.036）。然而，對於Charlson合併症指數（Charlson Comorbidity Index, CCI）評分低於4的患者，游離皮瓣並不能降低患肢截肢風險。結論：跟據我們的研究，游離皮瓣手術不能降低下肢骨髓炎患者患肢的截肢率，尤其是CCI評分低於4的患者。