PMC9081798_01
Clinical and radiological appearance of the patient prior, during, and after bacteriophage therapy. (A) Computed tomography revealing a fistula that connects femoral head and skin on the right upper third of the lateral femur surface. (B,C) Intraoperative findings from the right femoral head excision on the 5th of December revealing the presence of a femoral fistula. (D) Postoperative photograph showing irrigation system for local bacteriophage application. (E) The appearance of the wound two months after bacteriophage therapy.
fmed-09-851310-g0001.jpg
PMC9081798_01_fmed-09-851310-g0001.jpg
F1
Computed tomography with contrast injection in the cutaneous wound opening revealed a fistula that connects femoral head and skin on the right upper third of the lateral femur surface (Figure 1A). The pathology and intraoperative findings confirmed femoral head osteomyelitis with fistula (Figures 1B,C). Next, wound rinsing with 50 mL BFC 1.10 bacteriophage suspension was performed intraoperatively, tissue damage was replaced with a serratus muscle flap, and an irrigation system for local bacteriophage application was installed (Figure 1D). Two months later, the wound healed and there were no signs of inflammation (Figure 1E) that was reassured with magnetic resonance imaging (MRI) of the right hip. Radiography of the right hip and femur 15 months later did not reveal any signs of inflammation (Supplementary Figure 1).
Timeline showing surgical interventions, relevant antimicrobial therapy, and microbiological and pathology findings.
fmed-09-851310-g0002.jpg
PMC9081798_01_fmed-09-851310-g0002.jpg
F2
When the irrigation catheter was removed, the tip of the catheter was positive for Candida tropicalis, which was not treated (Figure 2).