Arch Plast Surg.  2020 Sep;47(5):460-466. 10.5999/aps.2020.00717.

A multi-institutional analysis of sternoclavicular joint coverage following osteomyelitis

• Othman S
• Elfanagely O
• Azoury SC
• Kozak GM
• Cunning J
• Rios-Diaz AJ
• Palvannan P
• Greaney P
• Jenkins MP
• Jarrar D
• Kovach SJ
• Fischer JP

• KMID: 2506698
• DOI: http://doi.org/10.5999/aps.2020.00717

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/m². 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 twostaged 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/m² vs. 32.9±9.1 kg/m²; 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.

Keyword

Osteomyelitis; Surgery, plastic; Reconstructive surgery; Clavicle