Post-Tibial Osteotomy: Managing Infection and Surgical Concerns

Post-Tibial Osteotomy Surgery

Hello: I underwent corrective surgery on my right leg on September 14, 2023 (using allograft bone and titanium alloy plate fixation).
On January 25, February 7, and March 7, 2024, I experienced post-surgical wound infections and underwent wound debridement, irrigation, and drainage procedures (the plate was not removed).
I would like to ask Dr.
Chen: 1.
Is it possible to perform debridement surgery without removing the plate? 2.
After 7 months of having the right leg correction, can the plate be removed and then undergo a fourth debridement, irrigation, and drainage procedure? (The wound has become infected again and requires treatment at the hospital.)

Eey, 50~59 year old female. Ask Date: 2024/04/18

Dr. Chen Yongxue reply Orthopedics

Infections are a frustrating complication, and if an infection occurs, the healing process of the bone will slow down.
In principle, if the plate can be removed, controlling the infection after debridement will be easier.
However, the section of the bone that needs correction will require an alternative fixation method.
If the plate cannot be removed, and there are signs of bone healing, it may be possible to leave it in place and manage the infection with debridement and antibiotics.
This approach essentially allows the bone healing and the infection to compete, suppressing the infection while promoting healing.
Once the bone has successfully healed, the plate can be removed.
However, this method takes more time and can be more challenging for the patient.
Thank you.

Reply Date: 2024/04/18

More Info

Post-tibial osteotomy is a surgical procedure often performed to correct deformities in the lower leg, and it can involve the use of bone grafts and fixation devices such as titanium plates. Infection following such surgeries is a significant concern and can complicate recovery. Based on your situation, let's address your questions regarding the management of infection and surgical concerns.

1. Can the plate remain in place during debridement surgery?
Yes, it is possible to perform debridement (cleaning out the infected tissue) without removing the titanium plate. The decision to keep the plate in place typically depends on the extent of the infection, the stability of the fixation, and the overall condition of the surrounding tissues. If the plate is stable and the infection is localized, surgeons may opt to leave it in place while addressing the infection. However, if there is significant infection around the plate or if the plate is contributing to the infection, removal may be necessary. The surgeon will assess the situation during the procedure and make the best decision based on the findings.

2. Is it possible to remove the plate and undergo a fourth debridement procedure after seven months?
Yes, it is feasible to remove the plate and perform another debridement if the infection persists. However, this decision will depend on several factors, including the severity of the infection, the patient's overall health, and the healing progress of the bone. If the infection has not resolved after multiple debridement procedures, it may indicate that the plate is a source of ongoing infection or that there are other underlying issues that need to be addressed. The surgeon will evaluate the wound, consider imaging studies, and possibly perform cultures to determine the best course of action.

In managing post-surgical infections, it is crucial to monitor for signs of infection such as increased redness, swelling, warmth, and discharge from the wound. Blood tests may also be conducted to assess inflammatory markers. Antibiotic therapy is typically initiated based on culture results and the sensitivity of the bacteria involved.

Infections can complicate recovery and may lead to longer healing times, chronic pain, or even the need for further surgeries. Therefore, it is essential to maintain open communication with your healthcare team. They can provide guidance on wound care, signs of infection to watch for, and the importance of adhering to prescribed antibiotic regimens.

In summary, while it is possible to manage infections without removing the fixation plate, the decision will ultimately depend on the specific circumstances of your case. If the infection continues to be a problem, further surgical intervention may be necessary. Always consult with your orthopedic surgeon for personalized advice and treatment options tailored to your situation.

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