The clinical outcome of debridement antibiotic and implant retention combined with myocutaneous flap transfer for chronic implant-associated infection
10.3760/cma.j.cn121113-20250218-00150
- VernacularTitle:保留假体清创联合肌皮瓣转移治疗骨肿瘤术后慢性内植物感染
- Author:
Qiyuan BAO
1
;
Junxiang WEN
1
;
Zhusheng ZHANG
1
;
Zhuochao LIU
1
;
Yuchen FU
1
;
Rong WAN
1
;
Yaoqi YANG
1
;
Yuhui SHEN
1
;
Weibin ZHANG
1
Author Information
1. 上海市交通大学医学院附属瑞金医院骨科（上海市伤骨科研究所），上海 200025
- Publication Type:Journal Article
- Keywords:
Bone neoplasms;
Implant-associated infection;
Myocutaneous flap;
Debridement
- From:
Chinese Journal of Orthopaedics
2025;45(10):647-653
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the clinical efficacy of a novel surgical approach of debridement, antibiotics, and implant retention (DAIR) with flap transfer, for treating chronic implant infections in bone tumor patients.Methods:A retrospective review was conducted on nine consecutive patients [6 males, 3 females; median age 35(27, 51) years, range 9-71] who underwent a modified procedure of DAIR plus flap transfer between November 2022 and January 2024. The cohort included six cases of chronic periprosthetic joint infection and three cases of chronic plate and screw infection. Tumor diagnoses included seven primary malignant tumors (osteosarcoma=5, undifferentiated pleomorphic sarcoma of bone=1, synovial sarcoma=1) and two bone metastasis of renal cell carcinoma. The procedure involved wide, radical debridement, meticulous removal of biofilm from implants and surrounding soft tissue, followed by the transfer of a well vascularized musculocutaneous flap to fully envelope the contaminated interface. Pre-operative clinicopathological data, surgical details, postoperative complications and infection recurrence were analyzed.Results:The median interval between initial implantation and debridement was 10.0(3.3, 14.8) months. Median follow-up after debridement was 15.9(15.4, 18.2) months. All nine surgeries were completed as planned: six musculocutaneous flaps, two fasciocutaneous flaps and one muscle-only flap. Implants were preserved in six patients; two required subsequent removal for recurrent infection, and one patient later underwent amputation for tumor recurrence. Infection-free implant survival at 3, 6 and 12 months was 88.9%, 87.5% and 87.5%, respectively. Major complications included one donor-site hematoma, one donor-site sensory deficit and one wound healing delay. All the complications were well management. Both reinfections occurred in proximal tibial prostheses, likely due to limited flap coverage options and local anatomical constraints.Conclusion:Although reinfections happened in two cases DAIR with flap transfer provides promising short-term infection control in patients with chronic implant-associated infections following bone tumor surgery.
