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A multi-institutional analysis of sternoclavicular joint coverage following osteomyelitis

Archives of Plastic Surgery 2020년 47권 5호 p.460 ~ 466
Othman Sammy, Elfanagely Omar, Azoury Said C., Kozak Geoffrey M., Cunning Jessica, Rios-Diaz Arturo J., Palvannan Prashanth, Greaney Patrick, Jenkins Matthew P., Jarrar Doraid, Kovach Stephen J., Fischer John P.,
소속 상세정보
 ( Othman Sammy ) - University of Pennsylvania Department of Surgery
 ( Elfanagely Omar ) - University of Pennsylvania Department of Surgery
 ( Azoury Said C. ) - University of Pennsylvania Department of Surgery
 ( Kozak Geoffrey M. ) - Thomas Jefferson University Department of Surgery
 ( Cunning Jessica ) - University of Pennsylvania Department of Surgery
 ( Rios-Diaz Arturo J. ) - University of Pennsylvania Department of Surgery
 ( Palvannan Prashanth ) - Thomas Jefferson University Department of Surgery
 ( Greaney Patrick ) - Thomas Jefferson University Department of Surgery
 ( Jenkins Matthew P. ) - Thomas Jefferson University Department of Surgery
 ( Jarrar Doraid ) - University of Pennsylvania Department of Surgery
 ( Kovach Stephen J. ) - University of Pennsylvania Department of Surgery
 ( Fischer John P. ) - University of Pennsylvania Department of Surgery

Abstract


Background: Sternoclavicular joint (SCJ) osteomyelitis is a rare pathology requiring urgent intervention. Several operative approaches have been described with conflicting reports. Here, we present a multi-institutional study utilizing multiple surgical pathways for SCJ reconstruction.

Methods: A multi-institutional retrospective cohort study was conducted to identify patients who underwent surgical repair for sternoclavicular osteomyelitis between 2008 and 2019. Patients were stratified according to reconstruction approach: single-stage reconstruction with advancement flap and delayed-reconstruction with flap following initial debridement. Demographics, operative approach, type of reconstruction, and postoperative outcomes were analyzed.

Results: Thirty-two patients were identified. Mean patient age was 56.2±13.8 years and 68.8% were male. The average body mass index (BMI) was 30.0±8.8 kg/m2. The most common infection etiologies were intravenous drug use and bacteremia (both 25%). Fourteen patients (43.8%) underwent one-stage reconstruction and 18 (56.2%) underwent delayed twostaged reconstruction. Both single and delayed-stage groups had comparable rates of reinfection (7.1% vs. 11.1%, respectively), surgical site complications (21.4% vs. 27.8%), readmissions (7.1% vs. 16.6%), and reoperations (7.1% vs. 5.6%; all P>0.05). The single-stage reconstruction group had a significantly lower BMI (26.2±5.7 kg/m2 vs. 32.9±9.1 kg/m2; P<0.05) and trended towards shorter hospital length of stay (11.3 days vs. 17.9 days; P=0.01).

Conclusions: Both single and delayed-stage approaches are appropriate methods with comparable outcomes for reconstruction for SCJ osteomyelitis. When clinically indicated, a singlestage reconstruction approach may be preferable in order to avoid a second operation as associated with the delayed phase, and possibly shortening total hospital length of stay.

키워드

Osteomyelitis; Surgery, plastic; Reconstructive surgery; Clavicle

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