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Robotic technology in wound healing osteomyelitis

B Martinez, MD, FACS
Epublication WebSurg.com, Mar 2014;14(03). URL: http://websurg.com/doi/lt03enmartinez002

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  • 2014-03-07
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Introduction: We initiated the use of robotic instrumentation in the surgical management of complex, recurrent non-healing wounds due to osteomyelitis in July 2012. The primary objective is to demonstrate the benefit of the visual superiority and more precise tissue dissection offered by robotic technology. Material and methods: After obtaining approval for the use of the da Vinci® robotic surgical system (Intuitive Surgical®) as an “exoscopic” approach at our institution, three patients were enrolled in the protocol wound debridement/osteomyelitis/da Vinci®. We will be presenting the clinical manifestations and imaging diagnosis of osteomyelitis, as well as outlining the surgical procedure and the use of the robotic system for soft tissue and bone debridement. The complimentary application of bioengineering tissue enhancement material was used in one patient (Cryopreserved amniotic membrane Amniox®), and in two patients (Apligraf Organogenesis, Inc). Comprehensive postoperative wound management will be discussed. Results: Two patients had completely healed wounds at 130 and 230 days respectively, without functional joint deficit. Although the third patient had only 3 weeks of follow-up, they appear to be progressing as expected. Conclusions: The basic capability of robotic technology (visual and manual control) appears to facilitate the surgical management of osteomyelitis, particularly in restricted anatomical spaces and in proximity to joints. We propose further clinical research and outcome healing measurements with this subgroup of patients that might otherwise require amputation.