• Clinics in Shoulder and Elbow
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• v.25 no.2
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• pp.154-157
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• 2022

Periprosthetic joint infection (PJI) is one of the most devastating complications that can occur after shoulder arthroplasty. Although staged revision arthroplasty is the standard treatment in many cases, surgical intervention with debridement, antibiotics, and implant retention (DAIR) can be an effective option for acute PJI. We report a complex case of infected reverse shoulder arthroplasty (RSA) in a 73-year-old male. The patient had been previously treated for infected nonunion of a proximal humerus fracture caused by methicillin-resistant Staphylococcus epidermidis. He presented with a sinus tract 16 days after the implantation of RSA and was diagnosed with PJI caused by Serratia marcescens. The patient was successfully treated with DAIR and was free of infection at the last follow-up visit at 4 years postoperatively.

• Hip & pelvis
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• v.34 no.4
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• pp.255-261
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• 2022

The purpose of this case report and review of the literature is to provide documentation on periprosthetic hip joint infection with Flavonifractor plautii (formerly known as Eubacterium plautii), a strictly anaerobic bacterium, and to report on a successful pathway for management including staged surgical revisions and extended antibiotic therapy. A systematic review of the literature was conducted, which identified this case as only the fifth documented case of human infection with this organism; as a result, conduct of further research is warranted, based on the paucity of reports in the literature addressing anaerobic periprosthetic joint infection.

• Archives of Plastic Surgery
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• v.40 no.6
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• pp.735-741
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• 2013

Background The prosthetic dura is an essential element in the protection of the cranial parenchyma and prevention of cerebrospinal fluid leakage. Although prosthetic dura are widely used in neurosurgery, they occasionally provoke infection, which can be a major concern after neurosurgical treatment. However, removal of the prosthetic dura carries a risk of brain parenchyma injury and cerebrospinal fluid leakage. The salvage of infected prosthetic dural material has not been adequately addressed in the literature. In this study, we demonstrate the value of the combination of a meticulous surgical debridement of necrotic tissue and simultaneous muscle free flap for intractable postoperative epidural abscess without removal of the infected prosthetic dura. Methods Between 2010 and 2012, we reviewed the data of 11 patients with persistent infection on the prosthetic dura. The epidural infections each occurred after a neurosurgical procedure, and there was soft tissue necrosis with the disclosure of the underlying prosthetic dura and dead bone around the scalp wound. To salvage the infected prosthetic dura, meticulous debridement and a muscle free flap were performed. Results All 11 patients experienced complete recovery from the complicated wound problem without the need for further surgical intervention. No signs of prosthetic dural infection were observed during the mean follow-up period of 11 months. Conclusions The combination of a meticulous surgical debridement and coverage with a muscle free flap is an effective treatment for salvage of infected prosthetic dura.

• Archives of Plastic Surgery
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• v.35 no.5
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• pp.597-602
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• 2008

Purpose: Presently, silicone rubber is chosen most frequently for nasal augmentation. However, there is a possibility of extrusion with this material. Sometimes, noses are prone to be traumatized, and then silicone rubber has a possibility of deformity or deviation resulting in trauma. We experienced cases with complications and traumatic deformities after the augmentation rhinoplasty. Methods: A retrospective review was performed to determine the characteristics of the implanted nasal silicone prosthesis after trauma. The patients' data such as deviation of implant, shape of fracture, age and sex of the patient, time of treatment, operative methods were reviewed. From March 2001 to March 2008, this study was performed in 30 patients. The patients were 25 females and 5 males, from 24 to 60 years of age, with an average of 42. All patients had previous augmentation rhinoplasty with silicone implant. Results: All of the 30 patients were confirmed as deviation of silicone and nasal bone fractures in the facial bone CT scan. The most common cause of fracture was traffic accident. The classification of nasal trauma after augmentation was done by facial bone CT. Class I: Deviation of silicone without nasal bone fracture without extrusion(12 cases, 40%), Class II: Deviation of silicone without nasal bone fracture and with extrusion(4 cases, 13%), Class III: Deviation of silicone with nasal bone fracture and without extrusion(8 cases, 27%), Class IV: Deviation of silicone with nasal bone fracture and with extrusion(3 cases, 10%), Class V: Mild deviation of silicone with nasal bone fracture(3cases, 3%). Specially, the comminuted or trapezoid nasal fracture was confirmed in 11 cases(Class III, IV). Conclusion: The problems of silicone implant have generally been related to foreign body reactions, rigidity of the material, encapsulation, infections, and extrusion. We experienced 11 cases of comminuted or comminuted trapezoid shaped fracture below nasal implant. So, we think this phenomenon could be used in late problem of silicone implant.

• Archives of Craniofacial Surgery
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• v.17 no.4
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• pp.229-232
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• 2016

None of the reports of delayed infection mentioned a latent period exceeding 13 months. we report an infection that developed 18 months after implantation of an absorbable plate. A 16-year-old adolescent girl had undergone reduction and fixation with an absorbable plate for Lefort I and zygomaticomaxillary complex fractures 18 months prior at our hospital. In her most recent hospital visit as an outpatient, abscess was observed in periocular area. Computed tomography revealed sinusitis with an abscess above the infraorbital rim. Wound culture yielded methicillin-resistant Staphylococcus aureus. Despite conservative treatments, wound state did not improve. Therefore, our department decided to perform surgery. Absorbable plate had been mostly absorbed but remained a bit. Bony depression of infraorbital rim and mucosal exposure of maxillary sinus anterior wall were observed. After the surgery, the patient recovered. We believe that the reason the wound infection and sinusitis manifested at the same time is because of several factor such as alcohol abuse, smoking, and mucosal exposure of maxillary sinus anterior wall. Absorbable plate takes 9 months to 3 years to be completely absorbed, thus we suggest studies with a follow-up of at least 3 years be undertaken to determine the outcomes of patients with many risk factors.

• Hip & pelvis
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• v.34 no.4
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• pp.236-244
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• 2022

Purpose: The most recent diagnostic criteria for periprosthetic joint infection (PJI) include the use of the alpha-defensin (AD) lateral-flow (LF) test, but hip and knee arthroplasties were usually combined in previous studies. This prospective study was designed to examine the accuracy of the AD-LF test for diagnosis of PJI in chronic painful total hip arthroplasties (THA). Materials and Methods: Patients with chronic painful hip arthroplasties were prospectively enrolled between March 2018 and May 2020. Exclusion criteria included acute PJI or an insufficient amount of synovial fluid. The modified Musculoskeletal Infection Society (MSIS) criteria were primarily used for PJI diagnosis. Fifty-seven patients were included in the analysis group. Revision surgery was not performed in 38 patients, for different reasons (clinical group); these patients remain "Schrödinger's hips": in such cases PJI cannot be excluded nor confirmed until you "open the box". Results: The result of the AD-LF test was positive in nine patients and negative in 48 patients. Six patients were diagnosed with PJI. AD-LF sensitivity (MSIS criteria) was 83% (95% confidence interval [CI] 36-100%) and specificity was 92% (95% CI 81-98%). The positive and negative predictive value were 56% and 98%, respectively. Conclusion: The AD test is useful in addition to the existing arsenal of diagnostic tools, and can be helpful in the decision-making process. Not all patients with chronical painful THA will undergo revision surgery. Consequently, in order to determine the reliable diagnostic accuracy of this test, future PJI diagnostic studies should include a second arm of "Schrödinger's hips".