{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T02:47:52Z","timestamp":1769309272569,"version":"3.49.0"},"reference-count":23,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,12,27]],"date-time":"2023-12-27T00:00:00Z","timestamp":1703635200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Chronic osteomyelitis is an invalidating disease, and its severity grows according to the infection's particular features. The Cierny\u2010Maiden criteria classify it according to the anatomical aspects (I to IV) and also by physiological class (A host being in good immune condition and B hosts being locally (L) or systemically (S) compromised). The surgical approach to chronic osteomyelitis involves radical debridement and dead space reconstruction. Two\u2010stage management with delayed reconstruction is the most common surgical management, while one\u2010stage treatment with concomitant reconstruction is a more aggressive approach with less available literature. Which method gives the best results is unclear. The purpose of this study is to compare single and two\u2010stage techniques.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The authors carried out a retrospective multicentric cohort study to compare two primary outcomes (bone union and infection healing) in one versus two\u2010stage reconstructions with vascularized bone flaps in 23 cases of limb osteomyelitis (22 patients, 23 extremities). Thirteen subjects (56.5%) sustained a single\u2010stage treatment consisting of a single surgery of radical debridement, concomitant soft tissue coverage, and bone reconstruction. Ten cases (43.5%) sustained a two\u2010stage approach: radical debridement, simultaneous primary soft tissue closure, and antibiotic PMMA spacers implanted in 7 patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>No statistical differences were observed between one\u2010 and two\u2010stage approaches in bone union rate and infection recurrence risk. Even though bone union seems to be higher and faster in the two\u2010stage than in the one\u2010stage group, and all infection relapses occurred in the one\u2010stage group, data did not statistically confirm these differences. Two of the six cases (33.3%) of bone nonunion occurred in compromised hosts (representing only 17.4% of our sample). The B\u2010hosts bone union rate was 50.0%, while it reached 78.9% in A\u2010hosts, but the difference was not statistically significant (<jats:italic>p<\/jats:italic>\u2009=\u2009.5392). Infection recurrence was higher in B\u2010hosts than in A\u2010hosts (<jats:italic>p<\/jats:italic>\u2009=\u2009.0086) and in <jats:italic>Pseudomonas aeruginosa<\/jats:italic> sustained infections (<jats:italic>p<\/jats:italic>\u2009=\u2009.0208), but in the latter case, the treatment strategy did not influence the outcome (<jats:italic>p<\/jats:italic>\u2009=\u2009.4000).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Bone union and infection healing rates are comparable between one and two\u2010stage approaches. <jats:italic>Pseudomonas aeruginosa<\/jats:italic> infections have a higher risk of infection relapse, with similar effectiveness of one\u2010 and two\u2010stage strategies. B\u2010hosts have a higher infection recurrence rate without comparable data between the two approaches. Further studies with a larger sample size are required to confirm our results and define B\u2010hosts' best strategy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>Level III of evidence, retrospective cohort study investigating the results of treatments.<\/jats:p><\/jats:sec>","DOI":"10.1002\/micr.31139","type":"journal-article","created":{"date-parts":[[2023,12,27]],"date-time":"2023-12-27T09:19:48Z","timestamp":1703668788000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Single\u2010stage versus two\u2010stage bone flap reconstruction in chronic osteomyelitis: Multicenter outcomes comparison"],"prefix":"10.1002","volume":"44","author":[{"given":"Alice","family":"Piccato","sequence":"first","affiliation":[{"name":"Orthopaedic and Traumatology Department ASL TO3 Ospedale Civile E. Agnelli Pinerolo  Pinerolo Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Crosio","sequence":"additional","affiliation":[{"name":"Hand Surgery and Reconstructive Microsurgery Department ASST (Azienda Socio Sanitaria Territoriale) Gaetano Pini CTO di Milano  Milano Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Antonini","sequence":"additional","affiliation":[{"name":"Infectious Diseases and Septic Orthopaedic Department ASL2 Ospedale di Albenga  Pietra Ligure Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruno","family":"Battiston","sequence":"additional","affiliation":[{"name":"Hand Surgery Department A.O.U. Citt\u00e0 Della Salute e Della Scienza di Torino, CTO\u2014Orthopaedic and Traumatology II  Torino Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Titolo","sequence":"additional","affiliation":[{"name":"Hand Surgery Department A.O.U. Citt\u00e0 Della Salute e Della Scienza di Torino, CTO\u2014Orthopaedic and Traumatology II  Torino Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierluigi","family":"Tos","sequence":"additional","affiliation":[{"name":"Hand Surgery and Reconstructive Microsurgery Department ASST (Azienda Socio Sanitaria Territoriale) Gaetano Pini CTO di Milano  Milano Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0404-3297","authenticated-orcid":false,"given":"Davide","family":"Ciclamini","sequence":"additional","affiliation":[{"name":"Hand Surgery Department A.O.U. Citt\u00e0 Della Salute e Della Scienza di Torino, CTO\u2014Orthopaedic and Traumatology II  Torino Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,12,27]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.idc.2005.07.009"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-1075-2402"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3182025070"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000088564.81746.62"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0029-1214163"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.1920161009"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.20501"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-198609000-00001"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.TA.0000087888.01738.35"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199704033361406"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)16727-5"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1086\/516149"},{"issue":"3","key":"e_1_2_8_14_1","first-page":"32","article-title":"The management of chronic osteomyelitis: Part II\u2014Principles of post\u2010infective reconstruction and antibiotic therapy","volume":"13","author":"Marais L. 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