[Principles of treatment for infected pseudarthoses]

Area of Science:

• Orthopedic Surgery
• Vascular Surgery
• Infectious Disease

Context:

• Severe extremity infections often necessitate complex management strategies.
• Challenges include compromised blood supply, bacterial infection, and bone damage.
• Amputation is frequently considered for non-responsive cases.

Purpose:

• To outline a comprehensive treatment approach for severe extremity infections.
• To emphasize the critical role of vascular assessment and surgical reconstruction.
• To highlight the importance of bacteriologic evaluation and targeted antibiotic therapy.

Summary:

• Optimal treatment involves assessing extremity blood supply and precise bacteriologic evaluation to determine the lowest effective antibiotic concentration.
• Surgical reconstruction to improve blood flow (e.g., lumbar sympathectomy) and correct fragment fixation are crucial.
• Multi-stage management, prioritizing vascular improvement, combined with rational surgical treatment and topical antibiotics, can resolve infection and promote bone union, potentially avoiding amputation.

Impact:

• This approach can successfully treat infections and achieve bone union in patients previously considered for amputation.
• Improved limb salvage rates and functional outcomes for patients with severe extremity infections.
• Provides a framework for optimizing surgical and antimicrobial strategies in complex orthopedic infections.