Cases reported "Osteomyelitis"

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11/849. Treatment of chronic osteomyelitis of the lower extremity using free flap transfer.

    Between 1987 and 1995, 25 patients with chronic osteomyelitis of the lower extremity were treated by transfer of muscle or musculocutaneous flap. The subsequent follow-up extended over more than three years. Five patients developed a recurrence. Two were reoperated on and healed completely; in two an amputation had to be performed; and in one the infection persists. recurrence occurred mainly in patients in whom the bone cavity could not be filled completely with muscle.
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12/849. Reverse venous outflow of a free fibular osteocutaneous flap: a salvage procedure.

    The authors report 2 patients with a massive bony defect of the tibia due to chronic osteomyelitis. They reconstructed the defect using a free vascularized fibular osteocutaneous flap. Unfortunately, venous insufficiency was diagnosed 24 hours postoperatively. The previous anastomosed veins were promptly explored. The peroneal veins of the vascularized fibular bone graft were noted to be full of thrombi. After thrombectomy, the vessels became very fragile and broke down easily. It was impossible to achieve normal antegrade venous outflow from the previous vein of the donor graft; however, they found that distal runoff of the peroneal vein achieved a reverse venous outflow from the donor graft. The great saphenous vein was dissected and reanastomosed to achieve adequate venous drainage. This procedure may offer an alternative treatment for a flap with venous insufficiency.
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13/849. A case of abnormal localization of osteomyelitis.

    A patient with osteomyelitis and abnormal localization of the changes is presented--left sterno-clavicular joint, the medial parts of the clavicular bone and the first rib, as well as the manubrium sterni. General and target radiography, tomography and chest CT-scan were performed. The reported case is of interest because of the rare localization, the characteristics of the X-ray conduct and the symptomatology in differential and diagnostic aspect.
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14/849. Long-term antibiotic treatment in geriatric diabetic foot infection.

    A case report involving a 77-year old diabetic patient with an arterial foot ulcer and subsequent osteomyelitic infection is presented. Due to the patient's ineligibility for surgical intervention, long term antibiotic treatment based upon multiple culture, bone biopsy, radiograms and isotope scanning was initiated. Complete resolution of the osteomyelitis defined by subjective as well as objective criteria was achieved after three months of antibiotic treatment. The common and atypical characteristics of the geriatric population coupled with treatment plan involving a multidisciplinary approach resulted in maintaining foot function and pain-free ambulation in this 77-year old patient.
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15/849. Pubic osteomyelitis and granuloma after bone anchor placement.

    The use of bone anchors as a superior fixation for suburethral slings is becoming popular. We present a case report of pubic osteomyelitis and granuloma after bone anchor placement. A 71-year-old woman underwent placement of a vaginal wall sling using pubic bone anchors placed through a suprapubic incision. Recurrent swelling of the mons pubis required re-exploration and removal of the anchors from an infected pubic bone. When symptoms persisted over the following 10 months, the patient underwent repeat surgery and excision of a pubic bone granuloma. The use of bone anchors in suburethral sling surgery is associated with possible increase in patient morbidity, and no benefit to the patient has been shown.
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16/849. Cold-hot mismatch between Tc-99m HMPAO-labeled leukocytes and Tc-99m ciprofloxacin in axial skeleton infections: a report of three cases.

    Radiolabeled leukocyte scintigraphy is a well-established technique for the diagnosis of inflammation and infection with a typical presentation of a hot spot within the abnormal areas. However, in some cases of osteomyelitis of the axial skeleton, a cold defect pattern has been described. Tc-99m ciprofloxacin is a new agent claimed to be specific for imaging sites containing viable bacteria. In this report, we present three cases of proved bacterial infection of the axial skeleton with a mismatch pattern between Tc-99m ciprofloxin and tagged leukocytes. Although Tc-99m-labeled leukocyte scanning showed a cold defect, probably caused by bone marrow replacement, the Tc-99m ciprofloxacin consecutively revealed a hot spot at the site of infection. These data suggest that Tc-99m ciprofloxacin should be a better agent than radiolabeled leukocytes for detecting osteomyelitis of the axial skeleton.
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17/849. osteomyelitis, lateral sinus thrombosis, and temporal lobe infarction caused by infection of a percutaneous cochlear implant.

    OBJECTIVE: cochlear implantation has become a routine operation in the last 10 years. The most common soft tissue complications with transcutaneous cochlear implants include infection or necrosis of the flap and extrusion of the implant and device failure. The most common complication reported with percutaneous devices include minor skin irritations at the pedestal site, retraction of skin from the pedestal site, and loosening of screws that retain the pedestal. We describe one case of lateral sinus thrombosis and secondary temporal lobe infarction caused by infection of a screw anchoring the percutaneous pedestal of an Ineraid implant. STUDY DESIGN: Case report. SETTING: Tertiary referral center. CONCLUSIONS: Intracranial complications of a percutaneous bone-anchored pedestal may occur with little prodrome. Computed tomography (CT) scan of the pedestal and bone anchoring screws may be indicated if local evidence of infection persists.
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18/849. Prevention of skin and soft tissue entrapment in tibial segment transportation.

    We report of a ten year old patient with soft tissue damage and bone defect of the tibia as a sequel of osteomyelitis. After excision and stabilization with an Ilizarov fixateur segment transportation was started. In order to avoid skin and soft tissue entrapment in the docking region, we used a metal cage as a space provider, which was shortened as segment transportation progressed. To our knowledge this simple method has not been described so far.
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19/849. A technique to preserve the shape of the calcaneus after massive osteomyelitis.

    osteomyelitis of the os calcis challenges the reconstructive surgeon. We present the case of a patient in which massive medullary osteomyelitis of the calcaneus was treated with a technique that preserves the bone shape. The medullary cavity of the bone was first emptied, preserving the cortical shell. Then a free muscle flap was used to fill up the dead space. Three months later autologous bone grafts were packed into the cavity. Full weight-bearing was commenced 4 months after this procedure. In the latest follow-up, 2 1/2 years, the patient has had no recurrence or difficulty with walking.
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20/849. Chronic recurrent multifocal osteomyelitis associated with chronic inflammatory bowel disease in children.

    Chronic recurrent multifocal osteomyelitis (CRMO) is a rare disease of children characterized by aseptic inflammation of the long bones and clavicles. No infectious etiology has been identified, and CRMO has been associated with a number of autoimmune diseases (including Wegener's granulomatosis and psoriasis). The relationship between CRMO and inflammatory bowel disease is poorly described. Through an internet bulletin board subscribed to by 500 pediatric gastroenterologists, we identified six inflammatory bowel disease patients (two with ulcerative colitis, four with Crohn's colitis) with confirmed CRMO. In all cases, onset of the bony lesions preceded the onset of bowel symptoms by as much as five years. Immunosuppressive therapy for the bowel disease generally resulted in improvement of the bone inflammation. Chronic recurrent multifocal osteomyelitis should be considered in any inflammatory bowel disease patient with unexplained bone pain or areas of uptake on bone scan. CRMO may be a rare extraintestinal manifestation of inflammatory bowel disease; alternatively, certain individuals may be genetically predisposed to the development of both diseases.
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