Document Detail

Major amputation of lower extremity: prognostic value of positive bone biopsy cultures.
MedLine Citation:
PMID:  23158785     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: To assess the correlation between culture results of section's osseous slice biopsy (SOB) and the distal infected site responsible for the amputation performed concomitantly during major amputation of lower extremity. The influence of a positive culture of SOB on the patients' outcome was also evaluated.
MATERIALS AND METHODS: We conducted a retrospective study of medical charts of patients who underwent SOB during major amputation of lower extremity at our institution from 2000 to 2009.
RESULTS: Fifty-seven patients (42 males/15 females, mean age 52.16years) who undergone major limb amputation (47 below knee and ten above knee) were included. The initial medical conditions of the investigated patients were: trauma (n=32), infection (n=13), trophic disorders (n=10) and tumor (n=2). The major cause of amputation was an uncontrolled infection, accouting for 64.9% of the cases (37/57) (foot=5, ankle=8, leg=24), the remaining 20 patients had trophic disorders of lower limb. Twenty-one (36.8%) from 57 biopsies were sterile, 12 (21.1%) doubtful and 24 (42.1%) positive. Thirty-one (54.4%) patients had an antibiotic-free interval before limb amputation. Independently of the bacterial species, 69.6% of the microorganisms identified from SOB were found in the distal infected site. Patients with positive SOB had a significantly longer interval between the decision to amputate the patient and the surgical procedure (200.2 vs. 70.1days; P<0.03) and a shorter total duration of antibiotic therapy before amputation than patients with negative SOB (3.68 vs. 6.08months; P<0.03). The delay for complete healing was significantly higher in patients with a positive SOB compared with those with a negative SOB (3.57 vs. 2.48months; P<0.03).
CONCLUSION: Our results suggest that the infection may extend from the distal site to the level of amputation in a large proportion of cases and that the delay with which the amputation is performed after the decision has been taken may play a role in this event.
LEVEL OF EVIDENCE: Study level IV: retrospective observationnal study.
D Vaznaisiene; E Beltrand; A P Laiskonis; Y Yazdanpanah; H Migaud; E Senneville
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Publication Detail:
Type:  Journal Article     Date:  2012-11-15
Journal Detail:
Title:  Orthopaedics & traumatology, surgery & research : OTSR     Volume:  99     ISSN:  1877-0568     ISO Abbreviation:  Orthop Traumatol Surg Res     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-02-05     Completed Date:  2013-07-16     Revised Date:  2013-10-31    
Medline Journal Info:
Nlm Unique ID:  101494830     Medline TA:  Orthop Traumatol Surg Res     Country:  France    
Other Details:
Languages:  eng     Pagination:  88-93     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Elsevier Masson SAS. All rights reserved.
Clinic of Infectious Diseases, Lithuanian University of Health Sciences, 120, Baltijos street, 47116 Kaunas, Lithuania.
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MeSH Terms
Antibiotic Prophylaxis / statistics & numerical data
Bone and Bones / microbiology*,  pathology*
Ischemia / surgery
Leg Injuries / surgery
Lower Extremity / injuries,  surgery*
Middle Aged
Osteomyelitis / diagnosis
Retrospective Studies
Surgical Wound Infection / surgery
Wound Healing

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