“Chongqing experiences” in treatment of bone infections_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 XIE Zhao

Department of Orthopaedics, First Affiliated Hospital (Chongqing Southwest Hospital), Army Medical University of Chinese PLA, Chongqing, 400038, P. R. China;

Corresponding?author：

XIE Zhao, Email: xiezhao54981@163.com

Keywords：

Bone infections; multi-disciplinary treatment; Chongqing experience

DOI：

10.7507/1002-1892.202512037

Video：

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Abstract Full text Figures/Tables Video References Cited by

Bone infection as one of the most challenging diseases in orthopedics, is characterized by a prolonged treatment and a high recurrence rate, imposing a significant disease burden on both patients and society. With the continuous emergence of drug-resistant bacteria and a deepening understanding of biofilm theory, traditional single-modality treatment have become inadequate in addressing these complex clinical challenges. This paper provides an in-depth analysis of the century-long dilemma in the treatment of bone infections. Through systematic theory, it shares the author’s “Chongqing experiences” in bone infection management—a systematic strategy proposed based on extensive clinical practice and theoretical summarization. This approach emphasizes the importance of multi-disciplinary treatment, staged treatment, precise debridement, and a comprehensive grasp of the principles underlying bone infection therapy. The article also discusses humanistic considerations and future prospects in the treatment of bone infections, aiming to offer practical and valuable basis for clinical management.

Citation： XIE Zhao. “Chongqing experiences” in treatment of bone infections. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(1): 45-53. doi: 10.7507/1002-1892.202512037 Copy

1.	Atta HM. Edwin Smith Surgical Papyrus: the oldest known surgical treatise. Am Surg, 1999, 65(12): 1190-1192.
2.	Klenerman L. A history of osteomyelitis from the Journal of Bone and Joint Surgery: 1948 TO 2006. J Bone Joint Surg (Br), 2007, 89(5): 667-670.
3.	Cortés-Penfield NW, Kulkarni PA. The history of antibiotic treatment of osteomyelitis. Open Forum Infect Dis, 2019, 6(5): ofz181. doi: 10.1093/ofid/ofz181.
4.	Compere EL, Schnute WJ, Cattell LM. The use of penicillin in the treatment of acute hematogenous osteomyelitis in children: Report of twelve consecutive cases. ann surg, 1945, 122(6): 954-962.
5.	Nana A, Nelson SB, McLaren A, et al. What’s new in musculoskeletal infection: Update on biofilms. J Bone Joint Surg (Am), 2016, 98(14): 1226-1234.
6.	Masters EA, Trombetta RP, de Mesy Bentley KL, et al. Evolving concepts in bone infection: redefining “biofilm”, “acute vs. chronic osteomyelitis”, “the immune proteome” and “local antibiotic therapy”. Bone Res, 2019, 7: 20. doi: 10.1038/s41413-019-0061-z.
7.	Yu X, Wu H, Li J, et al. Antibiotic cement-coated locking plate as a temporary internal fixator for femoral osteomyelitis defects. Int Orthop, 2017, 41(9): 1851-1857.
8.	Wu H, Shen J, Yu X, et al. Two stage management of Cierny-Mader type Ⅳ chronic osteomyelitis of the long bones. Injury, 2017, 48(2): 511-518.
9.	Wang X, Wang Z, Fu J, et al. Induced membrane technique for the treatment of chronic hematogenous tibia osteomyelitis. BMC Musculoskelet Disord, 2017, 18(1): 33. doi: 10.1186/s12891-017-1395-6.
10.	Luo F, Wang X, Wang S, et al. Induced membrane technique combined with two-stage internal fixation for the treatment of tibial osteomyelitis defects. Injury, 2017, 48(7): 1623-1627.
11.	Wang X, Yu S, Sun D, et al. Current data on extremities chronic osteomyelitis in southwest China: epidemiology, microbiology and therapeutic consequences. Sci Rep, 2017, 7(1): 16251. doi: 10.1038/s41598-017-16337-x.
12.	Wu H, Yu S, Fu J, et al. Investigating clinical characteristics and prognostic factors in patients with chronic osteomyelitis of humerus. Burns Trauma, 2019, 7: 34. doi: 10.1186/s41038-019-0173-0.
13.	Jia C, Wang X, Yu S, et al. An antibiotic cement-coated locking plate as a temporary fixation for treatment of infected bone defects: a new method of stabilization. J Orthop Surg Res, 2020, 15(1): 44. doi: 10.1186/s13018-020-1574-2.
14.	Yu S, Jiang B, Jia C, et al. Investigation of biofilm production and its association with genetic and phenotypic characteristics of OM (osteomyelitis) and non-OM orthopedic Staphylococcus aureus. Ann Clin Microbiol Antimicrob, 2020, 19(1): 10. doi: 10.1186/s12941-020-00352-4.
15.	Shen J, Sun D, Fu J, et al. Management of surgical site infection post-open reduction and internal fixation for tibial plateau fractures. Bone Joint Res, 2021, 10(7): 380-387.
16.	Shen J, Sun D, Yu S, et al. Radiological and clinical outcomes using induced membrane technique combined with bone marrow concentrate in the treatment of chronic osteomyelitis of immature patients. Bone Joint Res, 2021, 10(1): 31-40.
17.	Wu H, Jia C, Wang X, et al. The impact of methicillin resistance on clinical outcome among patients with Staphylococcus aureus osteomyelitis: a retrospective cohort study of 482 cases. Sci Rep, 2023, 13(1): 7990. doi: 10.1038/s41598-023-35111-w.
18.	Wu H, Sun D, Wang S, et al. Incidence and risk factors of recurrence in limb osteomyelitis patients after antibiotic-loaded cement spacer for definitive bone defect treatment. Bone Joint Res, 2023, 12(8): 467-475.
19.	Ren Y, Liu L, Sun D, et al. Epidemiological updates of post-traumatic related limb osteomyelitis in China: a 10 years multicentre cohort study. Int J Surg, 2023, 109(9): 2721-2731.
20.	Wu H, Wang X, Shen J, et al. Clinical characteristics and outcomes associated with culture-negative status in limb osteomyelitis patients. Bone Joint J, 2024, 106-B(7): 720-727.
21.	Shen J, Wei Z, Sun D, et al. Infographic: Chongqing technique-a method of stabilization for management of chronic osteomyelitis. Bone & Joint Research, 2024, 13(3): 124-126.
22.	Shen J, Wei Z, Wu H, et al. The induced membrane technique for the management of infected segmental bone defects. Bone Joint J, 2024, 106-B(6): 613-622.
23.	Wang X, Jia C, Wu H, et al. Activated allograft combined with induced menbrane technique for the reconstruction of infected segmental bone defects. Sci Rep, 2024, 14(1): 12587. doi: 10.1038/s41598-024-63202-9.
24.	Wu H, Wang S, Fu J, et al. Surgical management of fracture-related infection (FRI) in the proximal femur: treatment options and long-term outcome. BMC Musculoskelet Disord, 2025, 26(1): 358. doi: 10.1186/s12891-025-08609-9.
25.	Wu H, Wang S, Shen J, et al. Clinical features and sequelae of pediatric osteomyelitis following surgical treatment: a 10-year retrospective study. BMC Infect Dis, 2025, 25(1): 1373. doi: 10.1186/s12879-025-11795-5.
26.	Wang X, Wang S, Yang F, et al. Treatment of infected lower limb bone defects using the bone transport with locking plate technique (BTLP): A retrospective case series of 90 patients. Injury, 2025, 56(12): 112829. doi: 10.1016/j.injury.2025.112829.
27.	Han W, Shen J, Wu H, et al. Induced membrane technique: Advances in the management of bone defects. Int J Surg, 2017, 42: 110-116.
28.	Tsang SJ, Ferreira N, Simpson AHRW. The reconstruction of critical bone loss: the holy grail of orthopaedics. Bone Joint Res, 2022, 11(6): 409-412.
29.	Metsemakers WJ, Moriarty TF, Morgenstern M, et al. The global burden of fracture-related infection: can we do better? Lancet Infect Dis, 2024, 24(6): e386-e393.
30.	Moriarty TF, Metsemakers WJ, Morgenstern M, et al. Fracture-related infection. Nat Rev Dis Primers, 2022, 8(1): 67. doi: 10.1038/s41572-022-00396-0.
31.	Masters EA, Ricciardi BF, Bentley KLM, et al. Skeletal infections: microbial pathogenesis, immunity and clinical management. Nat Rev Microbiol, 2022, 20(7): 385-400.
32.	Walter N, Rupp M, Baertl S, et al. The role of multidisciplinary teams in musculoskeletal infection. Bone Joint Res, 2022, 11(1): 6-7.
33.	McNally MA, Small JO, Tofighi HG, et al. Two-stage management of chronic osteomyelitis of the long bones. The Belfast technique. J Bone Joint Surg (Br), 1993, 75(3): 375-380.
34.	Careri S, Vitiello R, Oliva MS, et al. Masquelet technique and osteomyelitis: innovations and literature review. Eur Rev Med Pharmacol Sci, 2019, 23(2 Suppl): 210-216.
35.	Alford AI, Nicolaou D, Hake M, et al. Masquelet’s induced membrane technique: Review of current concepts and future directions. J Orthop Res, 2021, 39(4): 707-718.
36.	Cierny G. Surgical treatment of osteomyelitis. Plast Reconstr Surg, 2011, 127 Suppl 1: 190S-204S.
37.	Simpson AH, Deakin M, Latham JM. Chronic osteomyelitis. The effect of the extent of surgical resection on infection-free survival. J Bone Joint Surg (Br), 2001, 83(3): 403-407.
38.	Cierny G, Mader JT, Penninck JJ. A clinical staging system for adult osteomyelitis. Clin Orthop Relat Res, 2003(414): 7-24.
39.	Metsemakers WJ, Fragomen AT, Moriarty TF, et al. Evidence-based recommendations for local antimicrobial strategies and dead space management in fracture-related infection. J Orthop Trauma, 2020, 34(1): 18-29.
40.	Metsemakers WJ, Morgenstern M, Senneville E, et al. General treatment principles for fracture-related infection: recommendations from an international expert group. Arch Orthop Trauma Surg, 2020, 140(8): 1013-1027.
41.	Aktuglu K, Erol K, Vahabi A. Ilizarov bone transport and treatment of critical-sized tibial bone defects: a narrative review. J Orthop Traumatol, 2019, 20(1): 22. doi: 10.1186/s10195-019-0527-1.
42.	Conway JD, Hlad LM, Bark SE. Antibiotic cement-coated plates for management of infected fractures. Am J Orthop (Belle Mead NJ), 2015, 44(2): E49-E53.
43.	Pan C, Zhou Z, Yu X. Coatings as the useful drug delivery system for the prevention of implant-related infections. J Orthop Surg Res, 2018, 13(1): 220. doi: 10.1186/s13018-018-0930-y.
44.	Wassif RK, Elkayal M, Shamma RN, et al. Recent advances in the local antibiotics delivery systems for management of osteomyelitis. Drug Deliv, 2021, 28(1): 2392-2414.
45.	Schwarz EM, McLaren AC, Sculco TP, et al. Adjuvant antibiotic-loaded bone cement: Concerns with current use and research to make it work. J Orthop Res, 2021, 39(2): 227-239.
46.	Lindholm C, Searle R. Wound management for the 21st century: combining effectiveness and efficiency. Int Wound J, 2016, 13 Suppl 2(Suppl 2): 5-15.
47.	Durai R, Mownah A, Ng PC. Use of drains in surgery: a review. J Perioper Pract, 2009, 19(6): 180-186.
48.	Ellabban MA, Awad AI, Hallock GG. Perforator-pedicled propeller flaps for lower extremity reconstruction. Semin Plast Surg, 2020, 34(3): 200-206.
49.	D’Arpa S, Toia F, Pirrello R, et al. Propeller flaps: a review of indications, technique, and results. Biomed Res Int, 2014, 2014: 986829. doi: 10.1155/2014/986829.
50.	D’Arpa S, Cordova A, Pignatti M, et al. Freestyle pedicled perforator flaps: safety, prevention of complications, and management based on 85 consecutive cases. Plast Reconstr Surg, 2011, 128(4): 892-906.
51.	Depypere M, Kuehl R, Metsemakers WJ, et al. Recommendations for systemic antimicrobial therapy in fracture-related infection: A consensus from an international expert group. J Orthop Trauma, 2020, 34(1): 30-41.
52.	Li HK, Rombach I, Zambellas R, et al. Oral versus intravenous antibiotics for bone and joint infection. N Engl J Med, 2019, 380(5): 425-436.
53.	Huang CY, Hsieh RW, Yen HT, et al. Short- versus long-course antibiotics in osteomyelitis: A systematic review and meta-analysis. Int J Antimicrob Agents, 2019, 53(3): 246-260.
54.	Liener UC, Enninghorst N, H?gel J, et al. Quality of life after surgical treatment of osteitis. Unfallchirurg, 2003, 106(6): 456-460.
55.	Strathdee SA, Hatfull GF, Mutalik VK, et al. Phage therapy: From biological mechanisms to future directions. Cell, 2023, 186(1): 17-31.
56.	Zhang Z, Sun J, Luo Y, et al. Advances in the application of multimodal nano-antimicrobial strategies in prosthetic joint infections: A systematic review. Int J Nanomedicine, 2025, 20: 13989-14013.
57.	Qin L, Yang S, Zhao C, et al. Prospects and challenges for the application of tissue engineering technologies in the treatment of bone infections. Bone Res, 2024, 12(1): 28. doi: 10.1038/s41413-024-00332-w.
58.	Su Q, Luo T, Pan M, et al. Bifunctional 3D-printed PEEK scaffolds incorporating hydrogel-encapsulated magnesium-quinone nanosheets for antibacterial activity and mandibular bone regeneration. Mater Today Bio, 2025, 35: 102607. doi: 10.1016/j.mtbio.2025.102607.
59.	Wang J, Zhang Q, Wang H, et al. A Sr@Ag-based spatiotemporal and step-release scaffold against chronic osteomyelitis, fabricated by coaxial 3D-printing. Biomaterials, 2025, 314: 122899. doi: 10.1016/j.biomaterials.2024.122899.
60.	Saeed K, McLaren AC, Schwarz EM, et al. 2018 international consensus meeting on musculoskeletal infection: Summary from the biofilm workgroup and consensus on biofilm related musculoskeletal infections. J Orthop Res, 2019, 37(5): 1007-1017.
61.	Ascione T, Barrack R, Benito N, et al. General assembly, diagnosis, pathogen isolation-culture matters: Proceedings of international consensus on orthopedic infections. J Arthroplasty, 2019, 34(2S): S197-S206.
62.	Tissingh EK, Marais L, Loro A, et al. Management of fracture-related infection in low resource settings: how applicable are the current consensus guidelines? EFORT Open Rev, 2022, 7(6): 422-432.
63.	Romanò CL, Tsantes AG, Papadopoulos DV, et al. Infectious disease specialists and teamwork strategies worldwide: the World Association against Infection in Orthopedics and Trauma (WAIOT) and SICOT continue to cooperate in fighting musculoskeletal infections. SICOT J, 2022, 8: E1. doi: 10.1051/sicotj/2022031.
64.	Hu W, Shi S, Lin J, et al. The lower rate of bone and joint infection in patients with open extremity fractures associated with vaccination prior to injury: a propensity-matched cohort study. Front Pharmacol, 2025, 16: 1546191. doi: 10.3389/fphar.2025.1546191.

1. Atta HM. Edwin Smith Surgical Papyrus: the oldest known surgical treatise. Am Surg, 1999, 65(12): 1190-1192.
2. Klenerman L. A history of osteomyelitis from the Journal of Bone and Joint Surgery: 1948 TO 2006. J Bone Joint Surg (Br), 2007, 89(5): 667-670.
3. Cortés-Penfield NW, Kulkarni PA. The history of antibiotic treatment of osteomyelitis. Open Forum Infect Dis, 2019, 6(5): ofz181. doi: 10.1093/ofid/ofz181.
4. Compere EL, Schnute WJ, Cattell LM. The use of penicillin in the treatment of acute hematogenous osteomyelitis in children: Report of twelve consecutive cases. ann surg, 1945, 122(6): 954-962.
5. Nana A, Nelson SB, McLaren A, et al. What’s new in musculoskeletal infection: Update on biofilms. J Bone Joint Surg (Am), 2016, 98(14): 1226-1234.
6. Masters EA, Trombetta RP, de Mesy Bentley KL, et al. Evolving concepts in bone infection: redefining “biofilm”, “acute vs. chronic osteomyelitis”, “the immune proteome” and “local antibiotic therapy”. Bone Res, 2019, 7: 20. doi: 10.1038/s41413-019-0061-z.
7. Yu X, Wu H, Li J, et al. Antibiotic cement-coated locking plate as a temporary internal fixator for femoral osteomyelitis defects. Int Orthop, 2017, 41(9): 1851-1857.
8. Wu H, Shen J, Yu X, et al. Two stage management of Cierny-Mader type Ⅳ chronic osteomyelitis of the long bones. Injury, 2017, 48(2): 511-518.
9. Wang X, Wang Z, Fu J, et al. Induced membrane technique for the treatment of chronic hematogenous tibia osteomyelitis. BMC Musculoskelet Disord, 2017, 18(1): 33. doi: 10.1186/s12891-017-1395-6.
10. Luo F, Wang X, Wang S, et al. Induced membrane technique combined with two-stage internal fixation for the treatment of tibial osteomyelitis defects. Injury, 2017, 48(7): 1623-1627.
11. Wang X, Yu S, Sun D, et al. Current data on extremities chronic osteomyelitis in southwest China: epidemiology, microbiology and therapeutic consequences. Sci Rep, 2017, 7(1): 16251. doi: 10.1038/s41598-017-16337-x.
12. Wu H, Yu S, Fu J, et al. Investigating clinical characteristics and prognostic factors in patients with chronic osteomyelitis of humerus. Burns Trauma, 2019, 7: 34. doi: 10.1186/s41038-019-0173-0.
13. Jia C, Wang X, Yu S, et al. An antibiotic cement-coated locking plate as a temporary fixation for treatment of infected bone defects: a new method of stabilization. J Orthop Surg Res, 2020, 15(1): 44. doi: 10.1186/s13018-020-1574-2.
14. Yu S, Jiang B, Jia C, et al. Investigation of biofilm production and its association with genetic and phenotypic characteristics of OM (osteomyelitis) and non-OM orthopedic Staphylococcus aureus. Ann Clin Microbiol Antimicrob, 2020, 19(1): 10. doi: 10.1186/s12941-020-00352-4.
15. Shen J, Sun D, Fu J, et al. Management of surgical site infection post-open reduction and internal fixation for tibial plateau fractures. Bone Joint Res, 2021, 10(7): 380-387.
16. Shen J, Sun D, Yu S, et al. Radiological and clinical outcomes using induced membrane technique combined with bone marrow concentrate in the treatment of chronic osteomyelitis of immature patients. Bone Joint Res, 2021, 10(1): 31-40.
17. Wu H, Jia C, Wang X, et al. The impact of methicillin resistance on clinical outcome among patients with Staphylococcus aureus osteomyelitis: a retrospective cohort study of 482 cases. Sci Rep, 2023, 13(1): 7990. doi: 10.1038/s41598-023-35111-w.
18. Wu H, Sun D, Wang S, et al. Incidence and risk factors of recurrence in limb osteomyelitis patients after antibiotic-loaded cement spacer for definitive bone defect treatment. Bone Joint Res, 2023, 12(8): 467-475.
19. Ren Y, Liu L, Sun D, et al. Epidemiological updates of post-traumatic related limb osteomyelitis in China: a 10 years multicentre cohort study. Int J Surg, 2023, 109(9): 2721-2731.
20. Wu H, Wang X, Shen J, et al. Clinical characteristics and outcomes associated with culture-negative status in limb osteomyelitis patients. Bone Joint J, 2024, 106-B(7): 720-727.
21. Shen J, Wei Z, Sun D, et al. Infographic: Chongqing technique-a method of stabilization for management of chronic osteomyelitis. Bone & Joint Research, 2024, 13(3): 124-126.
22. Shen J, Wei Z, Wu H, et al. The induced membrane technique for the management of infected segmental bone defects. Bone Joint J, 2024, 106-B(6): 613-622.
23. Wang X, Jia C, Wu H, et al. Activated allograft combined with induced menbrane technique for the reconstruction of infected segmental bone defects. Sci Rep, 2024, 14(1): 12587. doi: 10.1038/s41598-024-63202-9.
24. Wu H, Wang S, Fu J, et al. Surgical management of fracture-related infection (FRI) in the proximal femur: treatment options and long-term outcome. BMC Musculoskelet Disord, 2025, 26(1): 358. doi: 10.1186/s12891-025-08609-9.
25. Wu H, Wang S, Shen J, et al. Clinical features and sequelae of pediatric osteomyelitis following surgical treatment: a 10-year retrospective study. BMC Infect Dis, 2025, 25(1): 1373. doi: 10.1186/s12879-025-11795-5.
26. Wang X, Wang S, Yang F, et al. Treatment of infected lower limb bone defects using the bone transport with locking plate technique (BTLP): A retrospective case series of 90 patients. Injury, 2025, 56(12): 112829. doi: 10.1016/j.injury.2025.112829.
27. Han W, Shen J, Wu H, et al. Induced membrane technique: Advances in the management of bone defects. Int J Surg, 2017, 42: 110-116.
28. Tsang SJ, Ferreira N, Simpson AHRW. The reconstruction of critical bone loss: the holy grail of orthopaedics. Bone Joint Res, 2022, 11(6): 409-412.
29. Metsemakers WJ, Moriarty TF, Morgenstern M, et al. The global burden of fracture-related infection: can we do better? Lancet Infect Dis, 2024, 24(6): e386-e393.
30. Moriarty TF, Metsemakers WJ, Morgenstern M, et al. Fracture-related infection. Nat Rev Dis Primers, 2022, 8(1): 67. doi: 10.1038/s41572-022-00396-0.
31. Masters EA, Ricciardi BF, Bentley KLM, et al. Skeletal infections: microbial pathogenesis, immunity and clinical management. Nat Rev Microbiol, 2022, 20(7): 385-400.
32. Walter N, Rupp M, Baertl S, et al. The role of multidisciplinary teams in musculoskeletal infection. Bone Joint Res, 2022, 11(1): 6-7.
33. McNally MA, Small JO, Tofighi HG, et al. Two-stage management of chronic osteomyelitis of the long bones. The Belfast technique. J Bone Joint Surg (Br), 1993, 75(3): 375-380.
34. Careri S, Vitiello R, Oliva MS, et al. Masquelet technique and osteomyelitis: innovations and literature review. Eur Rev Med Pharmacol Sci, 2019, 23(2 Suppl): 210-216.
35. Alford AI, Nicolaou D, Hake M, et al. Masquelet’s induced membrane technique: Review of current concepts and future directions. J Orthop Res, 2021, 39(4): 707-718.
36. Cierny G. Surgical treatment of osteomyelitis. Plast Reconstr Surg, 2011, 127 Suppl 1: 190S-204S.
37. Simpson AH, Deakin M, Latham JM. Chronic osteomyelitis. The effect of the extent of surgical resection on infection-free survival. J Bone Joint Surg (Br), 2001, 83(3): 403-407.
38. Cierny G, Mader JT, Penninck JJ. A clinical staging system for adult osteomyelitis. Clin Orthop Relat Res, 2003(414): 7-24.
39. Metsemakers WJ, Fragomen AT, Moriarty TF, et al. Evidence-based recommendations for local antimicrobial strategies and dead space management in fracture-related infection. J Orthop Trauma, 2020, 34(1): 18-29.
40. Metsemakers WJ, Morgenstern M, Senneville E, et al. General treatment principles for fracture-related infection: recommendations from an international expert group. Arch Orthop Trauma Surg, 2020, 140(8): 1013-1027.
41. Aktuglu K, Erol K, Vahabi A. Ilizarov bone transport and treatment of critical-sized tibial bone defects: a narrative review. J Orthop Traumatol, 2019, 20(1): 22. doi: 10.1186/s10195-019-0527-1.
42. Conway JD, Hlad LM, Bark SE. Antibiotic cement-coated plates for management of infected fractures. Am J Orthop (Belle Mead NJ), 2015, 44(2): E49-E53.
43. Pan C, Zhou Z, Yu X. Coatings as the useful drug delivery system for the prevention of implant-related infections. J Orthop Surg Res, 2018, 13(1): 220. doi: 10.1186/s13018-018-0930-y.
44. Wassif RK, Elkayal M, Shamma RN, et al. Recent advances in the local antibiotics delivery systems for management of osteomyelitis. Drug Deliv, 2021, 28(1): 2392-2414.
45. Schwarz EM, McLaren AC, Sculco TP, et al. Adjuvant antibiotic-loaded bone cement: Concerns with current use and research to make it work. J Orthop Res, 2021, 39(2): 227-239.
46. Lindholm C, Searle R. Wound management for the 21st century: combining effectiveness and efficiency. Int Wound J, 2016, 13 Suppl 2(Suppl 2): 5-15.
47. Durai R, Mownah A, Ng PC. Use of drains in surgery: a review. J Perioper Pract, 2009, 19(6): 180-186.
48. Ellabban MA, Awad AI, Hallock GG. Perforator-pedicled propeller flaps for lower extremity reconstruction. Semin Plast Surg, 2020, 34(3): 200-206.
49. D’Arpa S, Toia F, Pirrello R, et al. Propeller flaps: a review of indications, technique, and results. Biomed Res Int, 2014, 2014: 986829. doi: 10.1155/2014/986829.
50. D’Arpa S, Cordova A, Pignatti M, et al. Freestyle pedicled perforator flaps: safety, prevention of complications, and management based on 85 consecutive cases. Plast Reconstr Surg, 2011, 128(4): 892-906.
51. Depypere M, Kuehl R, Metsemakers WJ, et al. Recommendations for systemic antimicrobial therapy in fracture-related infection: A consensus from an international expert group. J Orthop Trauma, 2020, 34(1): 30-41.
52. Li HK, Rombach I, Zambellas R, et al. Oral versus intravenous antibiotics for bone and joint infection. N Engl J Med, 2019, 380(5): 425-436.
53. Huang CY, Hsieh RW, Yen HT, et al. Short- versus long-course antibiotics in osteomyelitis: A systematic review and meta-analysis. Int J Antimicrob Agents, 2019, 53(3): 246-260.
54. Liener UC, Enninghorst N, H?gel J, et al. Quality of life after surgical treatment of osteitis. Unfallchirurg, 2003, 106(6): 456-460.
55. Strathdee SA, Hatfull GF, Mutalik VK, et al. Phage therapy: From biological mechanisms to future directions. Cell, 2023, 186(1): 17-31.
56. Zhang Z, Sun J, Luo Y, et al. Advances in the application of multimodal nano-antimicrobial strategies in prosthetic joint infections: A systematic review. Int J Nanomedicine, 2025, 20: 13989-14013.
57. Qin L, Yang S, Zhao C, et al. Prospects and challenges for the application of tissue engineering technologies in the treatment of bone infections. Bone Res, 2024, 12(1): 28. doi: 10.1038/s41413-024-00332-w.
58. Su Q, Luo T, Pan M, et al. Bifunctional 3D-printed PEEK scaffolds incorporating hydrogel-encapsulated magnesium-quinone nanosheets for antibacterial activity and mandibular bone regeneration. Mater Today Bio, 2025, 35: 102607. doi: 10.1016/j.mtbio.2025.102607.
59. Wang J, Zhang Q, Wang H, et al. A Sr@Ag-based spatiotemporal and step-release scaffold against chronic osteomyelitis, fabricated by coaxial 3D-printing. Biomaterials, 2025, 314: 122899. doi: 10.1016/j.biomaterials.2024.122899.
60. Saeed K, McLaren AC, Schwarz EM, et al. 2018 international consensus meeting on musculoskeletal infection: Summary from the biofilm workgroup and consensus on biofilm related musculoskeletal infections. J Orthop Res, 2019, 37(5): 1007-1017.
61. Ascione T, Barrack R, Benito N, et al. General assembly, diagnosis, pathogen isolation-culture matters: Proceedings of international consensus on orthopedic infections. J Arthroplasty, 2019, 34(2S): S197-S206.
62. Tissingh EK, Marais L, Loro A, et al. Management of fracture-related infection in low resource settings: how applicable are the current consensus guidelines? EFORT Open Rev, 2022, 7(6): 422-432.
63. Romanò CL, Tsantes AG, Papadopoulos DV, et al. Infectious disease specialists and teamwork strategies worldwide: the World Association against Infection in Orthopedics and Trauma (WAIOT) and SICOT continue to cooperate in fighting musculoskeletal infections. SICOT J, 2022, 8: E1. doi: 10.1051/sicotj/2022031.
64. Hu W, Shi S, Lin J, et al. The lower rate of bone and joint infection in patients with open extremity fractures associated with vaccination prior to injury: a propensity-matched cohort study. Front Pharmacol, 2025, 16: 1546191. doi: 10.3389/fphar.2025.1546191.

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