Autosterilization of Contaminated and Devascularized Bone Fragments Through a Subcutaneous Bone Pouch

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Abstract

Objectives:

The purpose of this article was to present results of cases using a subcutaneous bone pouch technique and to assess the potential “autosterilization” effect that occurs when these contaminated free bone fragments are placed in nontraumatized tissue.

Design:

Retrospective review of prospectively collected data.

Setting:

Community-Based Level 1 Trauma Center.

Patients/Participants:

Eight patients were consented for the described technique, and data were collected over an 8-year period.

Intervention:

Placement of fragments into a surgically created subcutaneous pouch in a nontraumatized tissue zone, followed by delayed, cultured, and attempted reimplantation at the initial injury site.

Main Outcome Measurements:

Culture results after extraction of bone fragments from subcutaneous bone pouch and clinical outcomes after reimplantation into initial open fracture site.

Results:

All 8 cases undergoing this technique resulted in healing of the subcutaneous bone pouch without signs or symptoms of infection at the time of attempted reimplantation or fragment removal. Four of the 8 cases had successful reimplantation and union at the open fracture site.

Conclusions:

Preserving devascularized bone fragments in a subcutaneous pouch in a region of nontraumatized tissue appears to be a safe procedure that allows for an “autosterilization” type of process to occur.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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