Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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A multi-institutional analysis of sternoclavicular joint coverage following osteomyelitis

  • Othman, Sammy (Division of Plastic Surgery, Department of Surgery, University of Pennsylvania) ;
  • Elfanagely, Omar (Division of Plastic Surgery, Department of Surgery, University of Pennsylvania) ;
  • Azoury, Said C. (Division of Plastic Surgery, Department of Surgery, University of Pennsylvania) ;
  • Kozak, Geoffrey M. (Division of Plastic Surgery, Department of Surgery, Thomas Jefferson University) ;
  • Cunning, Jessica (Division of Plastic Surgery, Department of Surgery, University of Pennsylvania) ;
  • Rios-Diaz, Arturo J. (Division of Plastic Surgery, Department of Surgery, University of Pennsylvania) ;
  • Palvannan, Prashanth (Division of Plastic Surgery, Department of Surgery, Thomas Jefferson University) ;
  • Greaney, Patrick (Division of Plastic Surgery, Department of Surgery, Thomas Jefferson University) ;
  • Jenkins, Matthew P. (Division of Plastic Surgery, Department of Surgery, Thomas Jefferson University) ;
  • Jarrar, Doraid (Division of Thoracic Surgery, Department of Surgery, University of Pennsylvania) ;
  • Kovach, Stephen J. (Division of Plastic Surgery, Department of Surgery, University of Pennsylvania) ;
  • Fischer, John P. (Division of Plastic Surgery, Department of Surgery, University of Pennsylvania)
  • Received : 2020.04.29
  • Accepted : 2020.07.29
  • Published : 2020.09.15
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Abstract

Background Sternoclavicular joint (SCJ) osteomyelitis is a rare pathology requiring urgent intervention. Several operative approaches have been described with conflicting reports. Here, we present a multi-institutional study utilizing multiple surgical pathways for SCJ reconstruction. Methods A multi-institutional retrospective cohort study was conducted to identify patients who underwent surgical repair for sternoclavicular osteomyelitis between 2008 and 2019. Patients were stratified according to reconstruction approach: single-stage reconstruction with advancement flap and delayed-reconstruction with flap following initial debridement. Demographics, operative approach, type of reconstruction, and postoperative outcomes were analyzed. Results Thirty-two patients were identified. Mean patient age was 56.2±13.8 years and 68.8% were male. The average body mass index (BMI) was 30.0±8.8 kg/㎡. The most common infection etiologies were intravenous drug use and bacteremia (both 25%). Fourteen patients (43.8%) underwent one-stage reconstruction and 18 (56.2%) underwent delayed two-staged reconstruction. Both single and delayed-stage groups had comparable rates of reinfection (7.1% vs. 11.1%, respectively), surgical site complications (21.4% vs. 27.8%), readmissions (7.1% vs. 16.6%), and reoperations (7.1% vs. 5.6%; all P>0.05). The single-stage reconstruction group had a significantly lower BMI (26.2±5.7 kg/㎡ vs. 32.9±9.1 kg/㎡; P<0.05) and trended towards shorter hospital length of stay (11.3 days vs. 17.9 days; P=0.01). Conclusions Both single and delayed-stage approaches are appropriate methods with comparable outcomes for reconstruction for SCJ osteomyelitis. When clinically indicated, a single-stage reconstruction approach may be preferable in order to avoid a second operation as associated with the delayed phase, and possibly shortening total hospital length of stay.

Keywords

References

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