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The efficacy of negative pressure wound therapy in treating sacroiliac joint tuberculosis with a chronic sinus tract: a case series.

Luo X, Tang X, Ma Y, Zhang Y, Fang S - J Orthop Surg Res (2015)

Bottom Line: The mean volume of drainage did not change during the control phase, but decreased from 29.17 ± 16.63 to 0.25 ± 0.87 ml in the intervention phase.The mean daily reduction of wound volume, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) in the intervention phase was greater than in the control phase (P < 0.05).All patients healed uneventfully.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, General Hospital of Chinese People's Liberation Army (301 Hospital), No. 28 Fuxing Road, Beijing, 100853, China. xiaoboluo213@yeah.net.

ABSTRACT

Objective: Tuberculous sacroiliitis with abscess accounts for approximately 50 % of all sacroiliac joint tuberculosis cases. Tuberculous abscesses spread into the sacroiliac joint capsule, subcutaneous tissue, and the skin, and finally becomes a skin sinus. As there are no previous reports about sacroiliac joint tuberculosis with a chronic sinus, we evaluated its clinical characteristics and management by negative pressure wound therapy.

Methods: A retrospective analysis of 12 patients with sacroiliac joint tuberculosis with chronic sinuses treated between January 2005 and January 2010 was conducted. Patients were treated with negative pressure wound therapy (NPWT). Treatment was divided into three phases: control phase, standard dressing changes daily for 4 weeks; interphase washout period, dressing changes every 3 days for 1 week; and intervention phase, no dressing changes until minimal sinus tract drainage (<5 ml per 24 h). Outcomes including the sinus healing time and the drainage volume were evaluated.

Results: The mean follow-up was 37.1 months. Sinus healing was observed at an average of 25.25 ± 7.23 (range, 20-42) days after initial treatment. The mean volume of drainage did not change during the control phase, but decreased from 29.17 ± 16.63 to 0.25 ± 0.87 ml in the intervention phase. The mean daily reduction of wound volume, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) in the intervention phase was greater than in the control phase (P < 0.05). Anti-tubercular therapy was administered an average of 14.00 ± 2.95 (range, 12-18) months. ESR and CRP returned to normal within 3 months after the sinus closure. Bony fusion was observed in 5 (41.7 %) patients, and fibrous ankylosis in the other patients at last follow-up. All patients healed uneventfully.

Conclusions: Early diagnosis of sacroiliac joint tuberculosis with a chronic sinus can be difficult. NPWT provides better healing of sacroiliac joint tuberculosis with a chronic sinus than standard dressing changes.

No MeSH data available.


Related in: MedlinePlus

a Sinus tracts in the left buttock. b Management with NPWT. c MRI of the sacroiliac joints: erosive changes and abscess involving the right sacroiliac joint and sinuses in the left buttock. d MRI demonstrating healed abscesses and solid bony fusion 36 months after NPWT and anti-tubercular therapy
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Fig4: a Sinus tracts in the left buttock. b Management with NPWT. c MRI of the sacroiliac joints: erosive changes and abscess involving the right sacroiliac joint and sinuses in the left buttock. d MRI demonstrating healed abscesses and solid bony fusion 36 months after NPWT and anti-tubercular therapy

Mentions: ESR and CRP returned to normal by 3 months following discharge. Anti-tuberculosis therapy was administered for an average of 14.00 ± 2.95 months (range, 12–18 months). Definitive bony fusion was observed in five (41.7 %) patients and fibrous ankylosis in 7 (58.3 %) (Figs. 4 and 5). The average time to bony fusion was 41.20 ± 9.23 months (range, 30–54 months). All sinus tracts healed without recurrence. At final follow-up, one (8.3 %) patient had a little discomfort occasionally. No other complications occurred.Fig. 4


The efficacy of negative pressure wound therapy in treating sacroiliac joint tuberculosis with a chronic sinus tract: a case series.

Luo X, Tang X, Ma Y, Zhang Y, Fang S - J Orthop Surg Res (2015)

a Sinus tracts in the left buttock. b Management with NPWT. c MRI of the sacroiliac joints: erosive changes and abscess involving the right sacroiliac joint and sinuses in the left buttock. d MRI demonstrating healed abscesses and solid bony fusion 36 months after NPWT and anti-tubercular therapy
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4525737&req=5

Fig4: a Sinus tracts in the left buttock. b Management with NPWT. c MRI of the sacroiliac joints: erosive changes and abscess involving the right sacroiliac joint and sinuses in the left buttock. d MRI demonstrating healed abscesses and solid bony fusion 36 months after NPWT and anti-tubercular therapy
Mentions: ESR and CRP returned to normal by 3 months following discharge. Anti-tuberculosis therapy was administered for an average of 14.00 ± 2.95 months (range, 12–18 months). Definitive bony fusion was observed in five (41.7 %) patients and fibrous ankylosis in 7 (58.3 %) (Figs. 4 and 5). The average time to bony fusion was 41.20 ± 9.23 months (range, 30–54 months). All sinus tracts healed without recurrence. At final follow-up, one (8.3 %) patient had a little discomfort occasionally. No other complications occurred.Fig. 4

Bottom Line: The mean volume of drainage did not change during the control phase, but decreased from 29.17 ± 16.63 to 0.25 ± 0.87 ml in the intervention phase.The mean daily reduction of wound volume, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) in the intervention phase was greater than in the control phase (P < 0.05).All patients healed uneventfully.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, General Hospital of Chinese People's Liberation Army (301 Hospital), No. 28 Fuxing Road, Beijing, 100853, China. xiaoboluo213@yeah.net.

ABSTRACT

Objective: Tuberculous sacroiliitis with abscess accounts for approximately 50 % of all sacroiliac joint tuberculosis cases. Tuberculous abscesses spread into the sacroiliac joint capsule, subcutaneous tissue, and the skin, and finally becomes a skin sinus. As there are no previous reports about sacroiliac joint tuberculosis with a chronic sinus, we evaluated its clinical characteristics and management by negative pressure wound therapy.

Methods: A retrospective analysis of 12 patients with sacroiliac joint tuberculosis with chronic sinuses treated between January 2005 and January 2010 was conducted. Patients were treated with negative pressure wound therapy (NPWT). Treatment was divided into three phases: control phase, standard dressing changes daily for 4 weeks; interphase washout period, dressing changes every 3 days for 1 week; and intervention phase, no dressing changes until minimal sinus tract drainage (<5 ml per 24 h). Outcomes including the sinus healing time and the drainage volume were evaluated.

Results: The mean follow-up was 37.1 months. Sinus healing was observed at an average of 25.25 ± 7.23 (range, 20-42) days after initial treatment. The mean volume of drainage did not change during the control phase, but decreased from 29.17 ± 16.63 to 0.25 ± 0.87 ml in the intervention phase. The mean daily reduction of wound volume, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) in the intervention phase was greater than in the control phase (P < 0.05). Anti-tubercular therapy was administered an average of 14.00 ± 2.95 (range, 12-18) months. ESR and CRP returned to normal within 3 months after the sinus closure. Bony fusion was observed in 5 (41.7 %) patients, and fibrous ankylosis in the other patients at last follow-up. All patients healed uneventfully.

Conclusions: Early diagnosis of sacroiliac joint tuberculosis with a chronic sinus can be difficult. NPWT provides better healing of sacroiliac joint tuberculosis with a chronic sinus than standard dressing changes.

No MeSH data available.


Related in: MedlinePlus