Single-stage versus two-stage bone flap reconstruction in chronic osteomyelitis: Multicenter outcomes comparison

Area of Science:

• Orthopedic Surgery
• Infectious Disease Management
• Reconstructive Surgery

Background:

• Chronic osteomyelitis is a debilitating condition requiring surgical intervention, typically debridement and reconstruction.
• Surgical approaches include one-stage (simultaneous reconstruction) and two-stage (delayed reconstruction) methods, with unclear comparative efficacy.
• The Cierny-Maiden criteria classify osteomyelitis severity based on anatomical and host physiological factors (A hosts vs. B hosts).

Purpose of the Study:

• To compare the outcomes of one-stage versus two-stage surgical techniques for chronic osteomyelitis.
• To evaluate bone union and infection healing rates between the two surgical approaches.
• To assess the influence of host factors and specific pathogens on treatment success.

Main Methods:

• Retrospective multicentric cohort study involving 23 cases of limb osteomyelitis (22 patients).
• Comparison of bone union and infection healing rates between one-stage (n=13) and two-stage (n=10) reconstructions using vascularized bone flaps.
• Analysis of outcomes based on Cierny-Maiden host classification (A vs. B) and specific bacterial infections.

Main Results:

• No statistically significant differences were found in bone union or infection recurrence rates between one-stage and two-stage approaches.
• While bone union appeared higher in the two-stage group and relapses in the one-stage group, these trends were not statistically significant.
• Compromised hosts (B-hosts) exhibited a significantly higher infection recurrence rate (p=0.0086).
• Pseudomonas aeruginosa infections also showed a higher risk of recurrence (p=0.0208), irrespective of the surgical strategy.

Conclusions:

• One-stage and two-stage surgical strategies demonstrate comparable efficacy for bone union and infection healing in chronic osteomyelitis.
• Pseudomonas aeruginosa infections are associated with increased relapse risk, with similar outcomes for both surgical approaches.
• Compromised hosts (B-hosts) face a higher risk of infection recurrence, necessitating further research for optimal management strategies.