PMC9901517_01
(a) Left shoulder lesion at initial presentation. Notable
cavitation, erythema, and purulence are seen. (b) Left shoulder lesion
recurrence following a previous open irrigation and debridement.
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Ch1.F1
Three years before presentation, the patient developed left shoulder and periscapular pain, erythema, and swelling that progressed to an open, draining lesion that was treated at an outside institution (Figs. 1-3).
(a) Left periscapular region following extensive irrigation and
debridement of the initial scapular lesion. A negative pressure wound
therapy system can be seen placed in the defect created following
debridement. (b) Left periscapular region following extensive irrigation and
debridement and split thickness skin grafting for final closure.
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Ch1.F2
Three years before presentation, the patient developed left shoulder and periscapular pain, erythema, and swelling that progressed to an open, draining lesion that was treated at an outside institution (Figs. 1-3).
X-ray of the left shoulder with placement of an
antibiotic-impregnated articulating spacer for the treatment of glenohumeral
septic arthritis secondary to extending scapular osteomyelitis.
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Ch1.F3
Three years before presentation, the patient developed left shoulder and periscapular pain, erythema, and swelling that progressed to an open, draining lesion that was treated at an outside institution (Figs. 1-3). The lesion progressed and ultimately led to the development of osteomyelitis of the scapula and a septic left glenohumeral joint that resulted in placement of a left shoulder antibiotic-impregnated articulating spacer (Fig. 3).
Clinical appearance of the patient's bilateral wrists at (a) terminal pronation and (b) neutral. The bilateral wrists demonstrate
profound edema and erythema over the dorsum of the wrists. A draining defect
is appreciable over the ulnar dorsum of the left hand.
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Ch1.F4
There was a 5 mm by 5 mm open lesion overlying the dorsum of the left hand that drained straw-colored fluid (Fig. 4).
(a) Anteroposterior (AP) and (b) lateral radiographs of the patient's right wrist and hand demonstrate no osseous changes secondary to osteomyelitis.
Significant edema can be appreciated in the soft tissues of the hand and
wrist on lateral imaging.
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Ch1.F5
Plain radiographs were unremarkable, while MRI of the bilateral hands demonstrated a heterogenous process predominantly surrounding the extensor tendon sheaths extending distal from the antebrachium to the level of the metacarpophalangeal joints, nearly completely replacing the dorsal soft tissues (Figs. 5-8).
(a) AP and (b) lateral radiographs of the patient's left wrist and
hand demonstrate no osseous changes secondary to osteomyelitis. Significant
edema can be appreciated in the soft tissues of the hand and wrist on
lateral imaging.
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Ch1.F6
Plain radiographs were unremarkable, while MRI of the bilateral hands demonstrated a heterogenous process predominantly surrounding the extensor tendon sheaths extending distal from the antebrachium to the level of the metacarpophalangeal joints, nearly completely replacing the dorsal soft tissues (Figs. 5-8).
Representative (a) axial and (b) sagittal views of the right wrist
and hand demonstrate no osseous changes secondary to osteomyelitis on
magnetic resonance imaging. Soft tissue edema is appreciable on the imaging.
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Ch1.F7
Plain radiographs were unremarkable, while MRI of the bilateral hands demonstrated a heterogenous process predominantly surrounding the extensor tendon sheaths extending distal from the antebrachium to the level of the metacarpophalangeal joints, nearly completely replacing the dorsal soft tissues (Figs. 5-8).
Representative (a) axial and (b) sagittal views of the left wrist
and hand demonstrate no osseous changes secondary to osteomyelitis on
magnetic resonance imaging. Soft tissue edema is appreciable on the imaging.
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Ch1.F8
Plain radiographs were unremarkable, while MRI of the bilateral hands demonstrated a heterogenous process predominantly surrounding the extensor tendon sheaths extending distal from the antebrachium to the level of the metacarpophalangeal joints, nearly completely replacing the dorsal soft tissues (Figs. 5-8).
Intraoperative appearance of the right wrist demonstrating
extensive purulent material evacuated from the dorsum of the hand.
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Ch1.F9
Irrigation and debridement were completed and notable for extensive purulence involving the subcutaneous tissues, extensor compartments, and extensor tendons (Figs. 9-10).
Intraoperative appearance of the left wrist showing (a) extensive
purulent material superficial to the extensor tendons and (b) the intact
extensor mechanism following debridement and irrigation.
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Ch1.F10
Irrigation and debridement were completed and notable for extensive purulence involving the subcutaneous tissues, extensor compartments, and extensor tendons (Figs. 9-10).
Representative photograph of the patient's left hand following
multiple irrigation and debridement procedures and continuous drainage and
poor wound healing.
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Ch1.F11
The left hand demonstrated a 5 mm by 5 mm wound located over the dorsum of the hand requiring debridement (Fig. 11).