Chronic
osteomyelitis:
An osseus infection that has progressed to bone necrosis and sequestrum formation.
Vague/ unclear chronic pain, chills, low grade fever local swelling and drainage normal leukocyte count, elevated erythrocyte sedimentation rate (ESR) and Creactive protein (CRP) levels
Divided in 2 basic steps: Debridement and obliteration of the subsequent dead space by soft tissue. Removal of hardware or fracture stabilization.
Includes excision of all sequestra along with any infected bone or soft tissue obliteration of residual dead space Recurrence rate 30% because insufficient debridement To decrease recurrence, requires: segmental resection application of external fixator immediate or delayed metaphyseal corticotomy
The
best option for reconstructing chronic osteomyelitic wounds muscle flaps The most common muscles used in freetransfer procedures latissimus dorsi and rectus abdominis The advantages of a muscle flap:
Post-operative
antibiotic decided by culture and sensitivity results. Widely used protocol in adults antibiotics intravenous for 46 weeks There are no clinical studies or documented records indicating the superiority of the 46week course of antibiotics over other durations.
The
advantage:
the beads fill dead space produced by debridement They provide local antibiotic concentrations that are much greater than the minimum inhibitory concentration for most pathogens isolated in orthopedic infections.
Terms:
treatment modalities of chronic osteomyelitis in the lower extremities, combined with antibacterial agents/ antibiotic. Articles published: 1955 - 2008.
Animal studies:
need more studies on angiogenesis and revascularization
Human studies:
shorter duration of antimicrobial treatment and well-vascularized flap coverage possible alternative guideline for treating chronic osteomyelitis in the lower extremities
No evidence that prolonged parenteral antibiotics will penetrate the necrotic bone. Studies that we need more in chronic osteomyelitis:
duration of antibiotic treatment clarify the role of angiogenesis