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Papineau Open Cancellous Bone Grafting for Chronic Osteomyelitis and Infected Nonunions of the Distal Lower Extremity

Asomugha, Eva U. MD; Alexander, Ian J. MD

Techniques in Foot & Ankle Surgery: June 2014 - Volume 13 - Issue 2 - p 108–117
doi: 10.1097/BTF.0000000000000033
CME Article

Papineau grafting, or open cancellous bone grafting, was initially described 40 years ago for the management of cavitary defects resulting from radical debridement of infected bone and soft tissue. Although minor modifications have been made to the original protocol as described by Papineau, the main stages of the procedure have been largely preserved. The 3 stages of the protocol include debridement of necrotic or infected tissue, open cancellous bone grafting, and soft tissue coverage. This paper will provide a review of the recent literature and describe the technique of open cancellous bone grafting. Illustrative cases of its application in foot and ankle surgery are also provided.

Dr. Eva Umoh Asomugha is Resident Physician, Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44122. Dr. Ian James Alexander is Clinical Professor, Department of Orthopedic Surgery, Medina Hospital, Medina, OH, 44256. From the Cleveland Clinic Health System, Cleveland, OH

All authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

The authors have disclosed that the U.S. Food and Drug Administration has not approved the use of rhBMP-2 for the treatment of bone grafts as discussed in this article. Please consult the product’s labeling for approved information.

Address correspondence and reprint requests to Eva U. Asomugha, MD, Cleveland Clinic Health System, 9500 Euclid Avenue, Cleveland, OH 44124. E-mail:


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