Osteomyelitis often follows severe open leg fractures with massive contamination or devascularized soft tissue and bone. Inadequate débridement or delayed coverage of the wound markedly increases the chances for development of this dreaded complication.Chronic osteomyelitis has been described as having evidence of endosteal and cortical infection of more than 6 months’ duration and as having “one or more foci in bone that contains pus, infected granulation tissue, sequestra, a draining sinus, and resistant cellulitis. The inflammatory foci are surrounded by sclerotic bone with poor blood supply and are covered by a thick, relatively avascular periosteum and scarred muscle and subcutaneous tissue.”
The most important step in the surgical treatment of osteomyelitis is thorough débridement of all devascularized and contaminated tissue, including bone, granulation tissue, and the scarred surrounding soft tissue. Timidity in resection of questionably infected bone will not be rewarded with success; a large segmental defect is easier to treat than a persistent or recurrent osteomyelitis. Subsequent management of the bone defect may be achieved with bone grafting, vascularized free bone transplantation, bone distraction lengthening, or a combination of these techniques. Antibiotic-impregnated beads may be fashioned and placed within or on bone defects and open fractures when significant contamination is suspected or as an interim measure before definitive flap treatment. Microsurgical muscle or fasciocutaneous flap transplantation has revolutionized treatment of osteomyelitis by allowing generous débridement to be covered by sufficient tissue previously unavailable from local sites. Treatment by using this method may reach 85%. Dr. Spyriounis performs such complex procedures for chronic osteomyelitis treatment.
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