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Infection of massive bone allografts

H M Dick1, R J Strauch

  • 1Department of Orthopaedic Surgery, Columbia-Presbyterian Medical Center, Columbia University, New York, NY.

Clinical Orthopaedics and Related Research
|September 1, 1994
PubMed
Summary
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Deep allograft infections after massive bone tumor resections are common, often polymicrobial, and necessitate allograft removal. Soft tissue complications are key risk factors, impacting limb salvage outcomes.

Area of Science:

  • Orthopedic Surgery
  • Oncology
  • Infectious Diseases

Background:

  • Massive allograft implantations are used in treating bone tumors.
  • Deep infection is a significant complication following allograft procedures.
  • Understanding risk factors and outcomes is crucial for patient management.

Purpose of the Study:

  • To analyze the incidence, risk factors, and outcomes of deep infections after massive allograft implantations.
  • To evaluate the effectiveness of salvage procedures and identify factors influencing limb salvage.

Main Methods:

  • Retrospective analysis of 75 massive allograft implantations.
  • Review of 10 cases with deep allograft infections.
  • Evaluation of outcomes using the revised Mankin classification.

Related Experiment Videos

  • Statistical analysis (Chi-square) for risk factors like chemotherapy.

    • Main Results:

    • 13.3% of patients developed deep allograft infections, mostly within 1 month post-surgery.
    • Polymicrobial infections occurred in 50% of cases.
    • Wound and soft tissue complications were major risk factors; chemotherapy was not significant.
    • All infected allografts required removal; limb salvage was achieved in 7/10 patients, with 3 requiring amputation.
    • Salvage options included vascularized fibula transfers and repeat allograft implantation (which also became infected).

    Conclusions:

    • Deep infection is a serious complication of massive allografts, often requiring allograft removal.
    • Meticulous soft tissue management, including flaps, is critical to prevent infection.
    • Outcomes are variable, with a significant need for amputation in some cases.