OBJECTIVETo investigate the treatment of infected total knee arthroplasty (TKA).

METHODSBetween 1983 and 2000, 6 patients with infection after TKAs were treated, including 2 men and 4 women, aged on average 63 years (44 - 75 years). Initial knee arthroplasty was performed for osteoarthritis in 4 patients and for rheumatoid arthritis in 2 knees. The timing of diagnosis of infection after knee arthroplasty averaged 50 months (range, 1 month-11 years). Simple debridement and antibiotic treatment were prescribed for 3 patients, debridement and one-stage reimplantation for 1, debridement and two-stage reimplantation for 1, and athrodesis for 1.

RESULTSOf the 3 patients with simple debridement, one was cured, one failed but underwent athrodesis later, and one lost to follow up. Two patients with reimplantation were cured and had good function recovery. All of the 6 patients were followed up on average for 4 years. No infection recurred except one who lost to follow-up.

CONCLUSIONSManagement of infection after total knee arthroplasty includes antibiotic suppression and debridement with prosthesis retention, insertion of another prosthesis as a one-stage or two-stage exchange technique, knee arthrodesis and amputation. These treatments have specific indications. To treat infection after total knee arthroplasty, suitable method should be taken according to patient's condition. Arthrodesis is the best salvage operation, though it may handicap patients' daily life. Reimplantation of another prosthesis could maintain a functional joint.

Adult ; Aged ; Arthrodesis ; Arthroplasty, Replacement, Knee ; adverse effects ; Debridement ; Female ; Humans ; Infection ; therapy ; Male ; Middle Aged ; Postoperative Complications ; therapy ; Reoperation

We report a case of corneal deposition of pigments from cosmetic contact lenses after intense pulsed-light (IPL) therapy. A 30-year-old female visited our outpatient clinic with ocular pain and epiphora in both eyes; these symptoms developed soon after she had undergone facial IPL treatment. She was wearing cosmetic contact lenses throughout the IPL procedure. At presentation, her uncorrected visual acuity was 2/20 in both eyes, and the slit-lamp examination revealed deposition of the color pigment of the cosmetic contact lens onto the corneal epithelium. We scraped the corneal epithelium along with the deposited pigments using a no. 15 blade; seven days after the procedure, the corneal epithelium had healed without any complications. This case highlights the importance of considering the possibility of ocular complications during IPL treatment, particularly in individuals using contact lenses. To prevent ocular damage, IPL procedures should be performed only after removing the lenses and applying eyeshields.
Adult ; Coloring Agents/*pharmacokinetics ; Contact Lenses/*adverse effects ; Cornea/*metabolism/pathology/*radiation effects ; Cosmetic Techniques/*adverse effects ; Debridement ; Epithelium, Corneal/surgery ; Female ; Humans ; Phototherapy/*adverse effects ; Postoperative Period ; Treatment Outcome ; Visual Acuity

OBJECTIVETo investigate therapeutic strategy on septic arthritis after arthroscopic anterior cruciate ligament reconstruction.

METHODSThe clinical data of 6 cases of septic arthritis after arthroscopic anterior cruciate ligament reconstruction in our department from March 2005 to February 2014 were analyzed. All the patients were male,ranging in age from 18 to 36 years old. After operation, the knee joint became painful and swollen, and ESR and CRP were both increased. Culture of joint fluid allowed the recovery of staphylococcus epidermidis. The patients were dealt with arthroscopic debridement and infusion-drainage. The clinical results were evaluated by Lysholm rating system and range of motion.

RESULTSThe infection of all the patients was controlled. The ESR and CRP both recovered to normal level. The score of Lysholm rating system ranged from 85 to 95,and the range of motion was 120 to 135 degree.

CONCLUSIONArthroscopic debridement combined with infusion-drainage is effective in septic arthritis after arthroscopic anterior cruciate ligament reconstruction.

Adolescent ; Adult ; Anterior Cruciate Ligament Reconstruction ; adverse effects ; Arthritis, Infectious ; therapy ; Arthroscopy ; methods ; Blood Sedimentation ; C-Reactive Protein ; analysis ; Debridement ; methods ; Drainage ; Humans ; Male

BACKGROUNDMedian sternotomy is considered the most usually performed procedure in cardiac operations. This study aimed to assess clinical effectiveness of bilateral pectoralis major muscle flaps (BPMMF) for management of sternal osteomyelitis and mediastinal infection following median sternotomy.

METHODSClinical data were collected and retrospectively analyzed from twelve patients who underwent the BPMMF transposition for management of sternal osteomyelitis and mediastinal infection following median sternotomy from January 2006 to June 2009. Procedure consisted of rigorous debridement of necrotic tissues, dead space obliteration using the BPMMF, and placement of drainage tubes connected to a negative pressures generator for adequate drainage.

RESULTSNo patients died of drainage, and all 12 patients had viable BPMMF when discharged from hospital. At 1 week post discharge, 2 patients presented with sternal infection but recovered following local debridement and medication. No patients showed infection recurrence during the follow-up period over 10 months.

CONCLUSIONSSternal osteomyelitis and mediastinal infection following median sternotomy may be effectively managed through rigorous debridement of infected soft tissues, resection of the damaged sternal segment, transposition of the BPMMF to fill the damaged sternum resulting from debridement, and adequate postoperative drainage.

Adolescent ; Adult ; Aged ; Debridement ; Follow-Up Studies ; Humans ; Male ; Mediastinitis ; surgery ; Middle Aged ; Osteomyelitis ; surgery ; Retrospective Studies ; Sternotomy ; adverse effects ; Sternum ; surgery ; Surgical Flaps ; Surgical Wound Infection ; surgery

OBJECTIVETo study the efficacy of self-made, antibiotic-loaded cement articulating spacer in the treatment of infected total knee arthroplasty.

METHODSThe self-made molds were used to form the spacer during the operation. From March 2002 to March 2007, 22 patients with infected knee arthroplasty (10 males with 10 knees, 12 females with 12 knees) were treated with this kind of spacer in our center. The mean age of the patients was 59.6 years old (33 to 75 years old). The interval time between primary arthroplasty and first onset of infective syndrome was 6.7 months (1 to 14 months). The diagnosis was established by the clinical presentation,serum laboratory inflammatory markers (white blood cell count,erythrocyte sedimentation rate and C-reactive protein) and knee aspiration. The serum laboratory inflammatory markers were used to measure the systemic response to infection. Clinical and radiographic follow-up was regularly performed by HSS score system and X-ray.

RESULTSAll the patients were followed, the average interval between debridement and reimplantation was 4.7 months (3 to 9 months) and the infection control rate was 100% after the implantation of spacer. The average follow-up duration after reimplantation was 29.8 months (10 to 64 months) and there was no recurrence of infection at the latest follow-up. The HSS score increased from 40.5+/-5.9 to 65.8+/-7.5 after the implantation of spacer, furthermore, the score reached 88.7+/-5.1 in average at the latest follow-up. The patient satisfaction rate was 95.3%.

CONCLUSIONThis self-made molds and spacers is a reliable approach for the management of infected knee arthroplasty with some virtues, such as providing a mobile and functional joint through the treatment course, decreasing the difficulty of reimplantation, avoiding of a long-term post-operative infusion and high effective for eradicating infection.

Adult ; Aged ; Anti-Bacterial Agents ; administration & dosage ; Arthroplasty, Replacement, Knee ; adverse effects ; Bone Cements ; Debridement ; Female ; Humans ; Male ; Middle Aged ; Prosthesis-Related Infections ; therapy ; Replantation

Prosthetic infection is one of the severe postoperative complications of arthroplasty. Mixed bacterial-fungal prosthetic infection is rare but can be disastrous. This case was a 76-year-old female suffered from prosthetic infection following total hip replacement due to femoral neck fracture and underwent multiple debridements. The culture of periprosthetic tissue was bacteriologically sterile following the first debridement, while the Staphylococcus hominis was identified in the second debridement in the previous hospitalization where fungal infection had not been considered. Thus the pathogen spectrum of anti-infection therapy failed to contain fungus. Ultimately, the culture result of our sampled periprosthetic tissue during the third debridement was Candida albicans without bacterium in our hospital. The fungal prosthetic infection was successfully treated by a two-stage revision with antifungal drugs. Accurate diagnosis and standardized treatment is the key to the therapy of infection after hip arthroplasty, especially for mixed bacterial-fungal prosthetic infection.
Aged ; Anti-Bacterial Agents/therapeutic use* ; Arthroplasty, Replacement, Hip/adverse effects* ; Debridement ; Female ; Fungi ; Hip Prosthesis/adverse effects* ; Humans ; Mycoses/drug therapy* ; Prosthesis-Related Infections/therapy* ; Reoperation ; Retrospective Studies ; Treatment Outcome

Objective: To examine the feasibility and technical considerations of thorough debridement using uniportal thoracoscopic surgery for tuberculous empyema complicated by chest wall tuberculosis. Methods: A retrospective analysis was conducted on 38 patients who underwent comprehensive uniportal thoracoscopy debridement for empyema complicated by chest wall tuberculosis in the Department of Thoracic Surgery, Shanghai Pulmonary Hospital, from March 2019 to August 2021. There were 23 males and 15 females, aged (M(IQR)) 30 (25) years (range: 18 to 78 years). The patients were cleared of chest wall tuberculosis under general anesthesia and underwent an incision through the intercostal sinus, followed by the whole fiberboard decortication method. Chest tube drainage was used for pleural cavity disease and negative pressure drainage for chest wall tuberculosis with SB tube, and without muscle flap filling and pressure bandaging. If there was no air leakage, the chest tube was removed first, followed by the removal of the SB tube after 2 to 7 days if there was no obvious residual cavity on the CT scan. The patients were followed up in outpatient clinics and by telephone until October 2022. Results: The operation time was 2.0 (1.5) h (range: 1 to 5 h), and blood loss during the operation was 100 (175) ml (range: 100 to 1 200 ml). The most common postoperative complication was prolonged air leak, with an incidence rate of 81.6% (31/38). The postoperative drainage time of the chest tube was 14 (12) days (range: 2 to 31 days) and the postoperative drainage time of the SB tube was 21 (14) days (range: 4 to 40 days). The follow-up time was 25 (11) months (range: 13 to 42 months). All patients had primary healing of their incisions and there was no tuberculosis recurrence during the follow-up period. Conclusion: Uniportal thoracoscopic thorough debridement combined with postoperative standardized antituberculosis treatment is safe and feasible for the treatment of tuberculous empyema with chest wall tuberculosis, which could achieve a good long-term recovery effect.
Male ; Female ; Humans ; Abscess/complications* ; Empyema, Pleural/etiology* ; Empyema, Tuberculous/complications* ; Retrospective Studies ; Thoracic Wall ; Debridement/adverse effects* ; China ; Chest Tubes/adverse effects* ; Tuberculosis/complications* ; Thoracic Surgery, Video-Assisted ; Drainage

PURPOSE: This study was conducted to evaluate the surgical outcomes of active infective endocarditis with aortic root abscess formation. MATERIALS AND METHODS: Between February 1999 and June 2012, 49 patients underwent surgery for active endocarditis with aortic root abscess. The infected valve was native in 29 patients and prosthetic in 20 patients. The patients' mean age was 50+/-14 years, and 36 patients were male. Surgery was urgent/emergent in 15 patients (31%). The abscess involved the aortic annulus (11), left ventricular outflow tract (18), fibrous trigone (16), and mitral annulus (4). In all patients, wide debridement of abscess and aortic valve replacement with or without patch reconstruction of aortic root or annulus was performed. RESULTS: There were 6 (12%) operative deaths. Causes of early mortality were sepsis (2) and multi-organ failure (4). On postoperative echocardiogram, there was significant improvement of left ventricular dimension (LVEDD, from 58.8+/-11.8 mm to 52.6+/-8.2 mm, p<0.001); however, LV ejection fraction was significantly decreased (from 61.4+/-12.0% to 49.8+/-16.5%, p<0.001). The mean follow-up duration was 68.7+/-40.4 months. There was no late death or recurrent endocarditis during follow up. New York Heart Association functional class significantly improved from 3.2+/-0.7 to 1.2+/-0.4 (p<0.001). Kaplan-Meier estimated survival at 10 years was 87.2%. CONCLUSION: Surgical treatment for active endocarditis with aortic root abscess is still challenging, and was associated with high operative mortality. Nevertheless, long-term survival was excellent with good functional capacity after recovery from the early postoperative period.
Abscess/*surgery ; Adult ; Aortic Valve/microbiology/*surgery ; Debridement ; Endocarditis/*surgery ; Female ; Follow-Up Studies ; Heart Valve Prosthesis/*microbiology ; Heart Valve Prosthesis Implantation/*adverse effects/mortality ; Humans ; Intraoperative Complications/epidemiology ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Retrospective Studies

OBJECTIVETo explore effect and the application value of continuous douche and vacuum sealing drainage (VSD) in refractory tissue, and joint infections after complete debridement.

METHODSAs retrospective analysis of treatment time and restoration or recurrence, from Jan. 2006 to Dec. 2007, 61 cases of refractory tissue, bone and joint infections underwent continuous douche and VSD combined with the treatment of anti-inflammatory and rehabilitation training after debridement in our hospital. The 61 patients included 39 males and 22 females with age ranging from 10 to 58 years with an average of (35 +/- 12) years, among whom 61 identified to have ankle ulcers combined with infections,open fracture combined with infections, sacrococcygeal pressure ulcers combined with infections, infections after hip replacement, infections after open fracture, and infections after skin avulsion postoperation were 11, 15, 9, 3, 5 and 18 cases respectively. The course was from 2 weeks to 11 months with an average of 4 months.

RESULTSIn all 61 patients,the mean healing time was 17, 36, 42, 24, 32, 29 and 28 days in ankle ulcers and infections, tibia and fibula open fracture and infections, femoral shaft fracture and infections, sacrococcygeal pressure ulcers and infections, infections after hip replacement, infections after open fracture, and infections after skin avulsion postoperation respectively. The replacement of VSD was 1, 2-4, 3-5, 1-3, 2-4, 2-3 and 1-3 times in each group respectively. There was no wound recurrence except for 2 cases with recurrent in 61 cases with external fixation nail hole semi-pathological fracture in 1 case of femoral shaft fracture and infection and 1 case of tibia and fibula fracture and infection after follow-up at least one year.

CONCLUSIONApplication of continuous douche and VSD can effectively decrease incidence of complications and promote the refractory tissue, bone and joint infections wound growth, healing and considerably shorten the healing time.

Adolescent ; Adult ; Bone Diseases ; pathology ; physiopathology ; surgery ; Child ; Debridement ; adverse effects ; Female ; Follow-Up Studies ; Humans ; Joint Diseases ; pathology ; physiopathology ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Suction ; methods ; Therapeutic Irrigation ; methods ; Time Factors ; Wound Healing ; Young Adult

OBJECTIVETo discuss the causes and treatments of wound infections after scoliosis surgery.

METHODSNine hundred and twenty-four caes of scoliosis were reviewed, and the clinical data of 15 cases of postoperative infection were analysed retrospectively.

RESULTSAll 15 cases underwent spinal posterior fusion with autologous bone graft using instrumentations. Seven were diagnosed as early infection, and 8 were delayed infection. Radical debridement was performed in all 15 cases. The duration of antibiotics administration was 10 to 34 days with continuous closed irrigation for 2 to approximately 4 weeks and primary closure for the wounds. All patients were followed up for an average of 3.5 years (2 to 7.5 years) with good outcomes and no recurrence.

CONCLUSIONWound infection following surgical correction of scoliosis primarily results from intraoperative seeding, although host-related and operation-related factors may contribute to its development. Once the infections are diagnosed, good results can be achieved by prompt surgical debridement, irrigation and reasonably administered antibiotics. Removal of hardware may be necessary in deep infections.

Adolescent ; Adult ; Anti-Bacterial Agents ; therapeutic use ; Child ; Debridement ; Female ; Follow-Up Studies ; Humans ; Male ; Retrospective Studies ; Scoliosis ; surgery ; Spinal Fusion ; adverse effects ; Staphylococcal Infections ; therapy ; Surgical Wound Infection ; therapy