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Treatment of Sternoclavicular Joint Infection by Joint Resection and Repair with Free Anterolateral Thigh Myocutaneous Flap - A Case Report

胸鎖骨關節感染之病患經關節移除後以前外側大腿游離肌皮瓣重建-病例報告

摘要


Background: The sternoclavicular joint (SCJ) is rarely involved in bone and joint infections. Most SCJ infections occur in immunocompromised patients and account for approximately 1% of all bone and joint infections^(1,2). The standard treatment for SCJ infections is still undetermined. It varies from using medication alone to performing extensive debridement with SCJ resection. In this report, we describe a case of a patient with severe SCJ infection that was managed with antibiotic therapy, a wide range of debridement with resection arthroplasty, and reconstruction with a free anterolateral thigh (ALT) myocutaneous flap. Aim and Objective: We present a case of a patient with SCJ infection concomitant with osteomyelitis of SCJ, which was successfully managed with radical SCJ resection and reconstruction with a free ALT myocutaneous flap as an alternative because local or regional flaps were not available. Materials and Methods: A previously healthy 60-year-old man presented to the emergency department because of fever that lasted for 2 days. A computed tomogram revealed an SCJ abscess with clavicular head erosion. The abscess extended to the pectoralis muscle submuscular space, right neck, and right shoulder. An emergency fasciotomy was performed. A wound culture revealed oxacillin-sensitive Staphylococcus aureus. After 1 week of antibiotic treatment, the open wound, which measured 25 × 6 cm^2, was reconstructed with a free ALT myocutaneous flap taken from the right thigh. Results: At his 1-month outpatient follow-up visit, a seroma and a hematoma were found underneath the flap. After simple debridement and drainage, no further sequela occurred. At the 6-month follow-up visit, the flap and wound were found to exhibit good healing. The patient was noted to have good right shoulder function after SCJ resection at that time. Conclusions: As a workhorse flap in modern microvascular reconstruction, the ALT myocutaneous flap provides sufficient soft tissue coverage with a versatile design and pliable skin paddle. It can be a good alternative for reconstructing an advanced SCJ infection defect, especially when a local flap or regional flaps, such as a pectoralis major myocutaneous flap or latissimus dorsi flap, are not available.

並列摘要


背景:在骨頭與關節的感染中,胸鎖骨關節是較少見的,只占其中的1%。大部分胸鎖骨關節感染都發生在免疫力低落之病人。目前胸鎖骨關節感染的治療方式還未有一個定論。從單純抗生素治療到擴創手術甚至胸鎖骨關節移除都有。文中我們分享了一個先前無任何病史的胸鎖骨關節感染案列。病患歷經抗生術治療、擴創手術、死骨切除術及胸鎖骨關節移除術,最終以前外側大腿游離肌皮瓣重建傷口。目的及目標:作者敘述一個成功治癒的胸鎖骨關節感染合併骨髓炎案例最後因無局部皮瓣可用而選擇前外側大腿游離肌皮瓣以重建傷口。材料及方法:一位先前無病痛史60歲男性因連續發燒兩天至急診。經檢查後診斷為胸鎖骨關節關節膿瘍合併肩骨骨髓炎,隨之安排緊急擴創手術。膿瘍範圍延伸至右頸部、右胸大肌下、右肩。手術後留下25 × 6平方公分。細菌報告為oxacillin敏感金色葡萄球菌。抗生素治療一星期後,傷口以右大腿前外側游離肌皮瓣重建。結果:一個月後在門診的追蹤發現皮瓣下血腫與血清腫。簡單清創引流後再無其他併發症。皮瓣與傷口在六個月後的追蹤癒合良好。另外,病患的右肩活動並無因為手術而受限。結論:前外側大腿皮瓣擁有多方面適用及其皮瓣適應性高的特性且往往能提供足夠的組織當作重建。因此在現今的顯微重建手術為最常使用之皮瓣。胸鎖骨關節感染術後的傷口重建以局部皮瓣如胸大肌皮瓣或闊背肌皮瓣為首選,但當局部皮瓣無法使用時,前大腿外側肌皮瓣是個不錯的選擇。

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