PMC9399936_01
A plantar foot abscess following a puncture injury before (a)
and after (b) debridement. The subsequent appearance of a dorsolateral fistula
after failed antibiotic treatment before (c) and after (d) debridement. (e, f) A CT scan showing cuboidal osteomyelitis with medullary bone
destruction (yellow arrows).
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Ch1.F1
Initial improvement was noted, but the condition relapsed 3-4 weeks after the completion of treatment, and a plantar abscess appeared (Fig. 1a). On admission to our hospital, the abscess was debrided (Fig. 1b), and samples were collected for microbiological analysis. Although infection of the skin and the underlying plantar soft tissue evolved favorably, the patient reported increased pain and inflammatory signs, and a fistula appeared in the dorsum of her foot 1.5 months after antibiotic therapy was initiated (Fig. 1c). The fistula was debrided (Fig. 1d), and samples were collected for bacterial culture. CT findings were consistent with cuboid osteomyelitis with medullary destruction (Fig. 1e, f).
(a) Intraoperative cuboid bone debridement. (b) The
medullary defect was filled with absorbable, gentamicin- and vancomycin-loaded,
calcium sulfate-hydroxyapatite biocomposites (CERAMENT G and V). (c)
An anteroposterior X-ray after surgery.
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Ch1.F2
Surgery consisted of the radical debridement of the medullary portion of the cuboid bone to remove all infected and necrotic tissue until healthy bone was exposed (Fig. 2a) as well as copious irrigation with saline solution to clean the lesion. The dead space (a large bony defect caused by debridement) was filled with two absorbable, 40 % hydroxyapatite and 60 % calcium sulfate biocomposites loaded with either gentamicin (CERAMENT G) or vancomycin (CERAMENT V) (BONESUPPORT, Lund, Sweden) (Fig. 2b). Postoperative magnetic resonance imaging (MRI) confirmed the correct filling of the defect with the bone graft substitute (Fig. 2c).
X-ray (medial oblique view) images taken before and after the
surgery: (a) an X-ray image taken before surgery, and X-ray images taken at 2 d (b), 4 weeks (c), and 16 weeks (d) post-surgery, showing the resolution of inflammatory
and infectious parameters, correct healing, and the evolution of soft tissues.
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Radiographs taken 4 months after the surgery (Fig. 3) showed increased cuboid bone formation and active remodeling of the biomaterial into medullary bone.