The reconstruction of posttraumatic defects of bone and soft tissue, as well as residual deformities of the bone is often a lengthy and complicated procedure. Multiple surgical interventions are necessary to reconstruct the affected extremity and restore its functionality. To achieve an optimal result it often takes months or years and requires great patience and compliance of the patient. This treatment should be carried out in centers with the appropriate instrumental and human resources. Since the pathologies are often complex with bony deformities or loss of bone, as well as infections and soft tissue defects, the treatment should be carried out by very experienced surgeons to successfully manage these complex reconstructions. This often requires interdisciplinary cooperation, especially with experienced plastic surgeons. A soft tissue reconstruction for better blood circulation in the exposed bony structures, as well as the bony defects themselves, can be reconstructed at the same time.
UNASSIGNED: Die Rekonstruktion posttraumatischer Defekte von Knochen und Weichteilen sowie verbliebener Deformitäten ist ein oft langwieriges und kompliziertes Verfahren. Mehrfache operative Eingriffe sind notwendig, um nach Monaten bis Jahre ein optimales Ergebnis zu erreichen und letztendlich die Funktionsfähigkeit der betroffenen Extremität wieder herzustellen. Diese Behandlung sollte durch sehr erfahrene Operateure durchgeführt werden, die auch über die entsprechenden instrumentellen und personellen Ressourcen verfügen, um diese komplexen Rekonstruktionen erfolgreich durchzuführen. Hier bedarf es nicht selten einer interdisziplinären Zusammenarbeit insbesondere mit versierten plastischen Chirurgen. Eine weichteilige Deckung zur besseren Durchblutung der freiliegenden knöchernen Strukturen als auch knöcherne Defekte an sich, können so gemeinsam wieder rekonstruiert werden.

OBJECTIVE: A central role of infections in the treatment of MRONJ patients is widely accepted. An investigation of the MRONJ lesions\' biofilms as potential pathogens seems logical.
METHODS: We investigated the clinical data of our MRONJ patients who received surgery in advanced stage of the disease. Special attention was granted to the local colonizers harvested from osseous MRONJ specimens and submucosal putrid infections.
RESULTS: Eleven out of 71 patients presented a spontaneous onset of the disease and for 60 out of 71 patients a trigger was detected. Breast cancer (29.6%) and prostate cancer (22.5%) were the most frequent underlying disease for prescription of an antiresorptive therapy, mostly zoledronate. Submucosal soft tissue biofilms significantly differed from biofilms harvested from the MRONJ lesions bottom, yet the most frequent bacteria were equally present in both groups: Streptococcus species (spp.), Prevotella spp., Actinomyces spp., Veillonella spp., and Parvimonas micra. The cephalosporins, cefuroxime and cefotaxime, and ß-lactam antibiotics with ß-lactamase inhibitor revealed the greatest susceptibility for the detected bacteria.
CONCLUSIONS: The bacteria from the submucosal areas and the bottom of the infected bone presented comparable susceptibility to the common antibiotics regimes. Streptococcus spp., Prevotella spp., and Veillonella spp. present a high abundance in MRONJ lesions beside Actinomyces spp. The MRONJ lesions bottom is in many cases not infected by Actinomyces spp.
CONCLUSIONS: The removal of the necrotic bone reduces the variety of bacteria found in MRONJ lesions, in particular at the bottom of the lesion.

Surgery of sepsis in trauma surgery and orthopedics is attracting increasingly more attention due to the rising presence of multidrug-resistant pathogens and the increasing number of operative interventions. Despite extensive experience over decades neither the symptoms nor the treatment strategies have been evaluated and it has become obvious that a scientific investigation of this complex topic is necessary for optimization of patient care under economically sound conditions. The aim of this article is to give a snapshot from German healthcare institutions for trauma surgery and orthopedics to answer some questions on this topic from the section for bone and soft tissue infections (SeKuWi) of the German Society for Orthopedics and Trauma (DGOU) in cooperation with the German Society for Hospital Hygiene (DGKH).