Continuous local antibiotic perfusion (CLAP) for fracture-related infection after reconstruction of primary alveolar soft part sarcoma in the right thigh: A case report

Post-operative infection during adjuvant therapy of bone and soft tissue tumors often turns refractory leading to amputation. Therefore, new treatment options are needed to control the infection. A 56-year-old woman underwent wide resection and subsequent bone reconstruction with a liquid nitrogen-treated autograft for alveolar soft part sarcoma (ASPS) on the distal side of the right thigh. Two weeks thereafter, a second operation was done involving an implant with an intramedullary nail for a periprosthetic fracture; continuous resection of a pseudoaneurysm at fracture site was carried out one month later. Nevertheless, uncontrolled local infection soon developed. Therefore, continuous local antibiotic perfusion (CLAP) was directed to the infected site with the use of one intra-medullary antibiotic perfusion (iMAP) pin and one intra-soft tissue antibiotic perfusion (iSAP) tube, whereby the infection was immediately controlled. At 1.5 years after CLAP, the fracture had healed without recurrence of infection or tumor. CLAP is an effective antibiotic delivery system for fracture-related infection; it preserves both the implant and the biologically inactive bone affected by adjuvant therapy for sarcoma.