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Kim, Lee, Cho, Jo, and Kim: Treatment for the Recalcitrant Anterior Shin Skin Lesion after Chronic Osteomyelitis of the Tibia: Diaphyseal Osteoplasty and Soft Tissue Primary Closure
Original Article

Journal of the Korean Orthopaedic Association 2016; 51(3): 238-245.

Published online: 22 June 2016

DOI: https://doi.org/10.4055/jkoa.2016.51.3.238

Treatment for the Recalcitrant Anterior Shin Skin Lesion after Chronic Osteomyelitis of the Tibia: Diaphyseal Osteoplasty and Soft Tissue Primary Closure

Hyoung Min Kim, M.D., Jae Young Lee, M.D.*, Hyung Lae Cho, M.D., Hong Jo, M.D., Duc Hee Kim, M.D.

Department of Orthopaedic Surgery, Good Samsun Hospital, Busan, Korea.

*Department of Orthopaedic Surgery, The Catholic University of Korea, Bucheon St. Mary's Hospital, Bucheon, Korea.

Correspondence to: Hyung Lae Cho, M.D. Department of Orthopaedic Surgery, Good Samsun Hospital, 326 Gaya-daero, Sasang-gu, Busan 47007, Korea. TEL: +82-51-310-9289, FAX: +82-51-310-9348, hljo88@hanmail.net

Received 31 July 2015       Revised 4 October 2015       Accepted 28 October 2015

Copyright © 2016 by The Korean Orthopaedic Association

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We aimed to report the clinical results of diaphyseal osteoplasty and primary soft tissue closure in recalcitrant poor skin lesion with superficial or localized bone infection on the anterior shin after chronic osteomyelitis.

Materials and Methods

We retrospectively reviewed 7 patients with poor shin skin lesion complicated by superficial and localized bone infection after chronic osteomyelitis. The average duration of chronic osteomyelitis was 39 years. After excision of the poor skin lesion, diaphyseal osteoplasty of the tibia was performed for the resection of infected bone and primary closure of the soft tissue defect. Postoperative results were evaluated with recovery of skin lesion, the amount of bone resection by osteoplasty and complications including recurrence of osteomyelitis.

Results

Mean size of excised skin lesion during surgery was 3.0×14.1 cm and successful primary closures of the defect were possible in all cases. All shin skin lesions were recovered and the amount of resected bone was mean of 18.7% of the anteroposterior diameter of the tibia. There was no recurrence of skin lesion, osteomyelitis or stress fracture.

Conclusion

After treatment of a previous intramedullary infection in chronic osteomyelitis of the tibia, recalcitrant poor shin skin lesion complicated with superficial or localized bone infection was effectively recovered by diaphyseal osteoplasty and primary soft tissue closure. This procedure is relatively simple compared to other surgeries and effective in recovery of healthy shin skin without recurrence of osteomyelitis.

Keywords: tibia, chronic osteomyelitis, osteoplasty, primary closure, skin lesion

Figures and Tables

Figure 1

Schematic diagrams of diaphyseal osteoplasty. (A) Preoperative axial extent of poor skin lesion (between a and b). Asterisk indicates the amount of bone supposed to be resected. (B) Postoperative apposition of the defect (ab) by soft tissue primary closure.

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Figure 2

Photographs of diaphyseal osteoplasty. (A) Preoperative finding of the left shin shows papered thinned scarring and exposure of infected bone. Planned scar excision (B) and osteoplasty with bone chisel (C). (D) Postoperative finding shows successful primary closure.

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Figure 3

Resection rate was calculated by measurement of preoperative (a) and postoperative (b) anteroposterior diameters of the tibia at the same height (h) on a lateral X-ray.

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Figure 4

Photographs and X-rays of the case 1 patient. (A) A 72-year-old male patient had a skin problem in the middle 1/3 of his left shin for 50 years. The soft tissue defect (4×16 cm) and surrounding poor skin condition were noted. (B) Postoperative radiographs after saucerization and diaphyseal osteoplasty with bone resection showed a straightened anterior cortex of the tibia. (C) Tension-free approximation and additional release on the lateral part of the leg were performed and the resultant defect was covered by a full thickness skin graft. (D) Radiographs 16 months after the operation show a completely healed lesion and acceptable remodeling.

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Figure 5

Photographs and X-rays of the case 4 patient. (A) A 73-year-old female patient had skin problem in the mid-leg for 60 years. Thinned papered poor shin skin (5×20 cm) and multiple bone exposure with sinus drainage implied chronic osteomyelitis. Radiographs showed an impending pathologic fracture. (B) Under the impression of chronic osteomyelitis, sequestrectomy, diaphyseal osteoplasty, and external fixation were performed. After release of deep fascia, tension-free approximation was possible without additional treatment. (C) At 1 year follow-up, healthy normal skin with a linear scar was observed on the mid leg and radiographs showed a well remodeled tibia shaft.

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Table 1

Preoperative Demographic Data of 7 Patients

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OM, osteomyelitis; CM, Cierny and Mader classification of chronic osteomyelitis; M, male; F, female; H, hematogenous; PT, post-traumatic.

Table 2

Postoperative Data of 7 Patients

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*(Maximum width of excised scar tissue)×(length of wound). †(Preoperative anteroposterior diameter of tibia-postoperative) anteroposterior diameter of tibia)×100/preoperative anteroposterior diameter of tibia in lateral simple X-ray view. FTSG, full thickness skin graft; EF, external fixation.

Notes

CONFLICTS OF INTEREST The authors have nothing to disclose.

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