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[Malignant degeneration of fistulas in chronic osteomyelitis (author's transl)]
Abstract:
The malignant degeneration of a skin ulcer has been reported as early as in 1884. In spite of this, however, the danger of malignant degeneration of sinus tracts associated with recurrences of chronic osteomyelitis is still underestimated. This development is neither restricted to case histories of years and decenniums nor to elderly patients and may also involve any part of the skeleton. Usually patients become aware of suddenly increasing tenderness and purulation, "washed out" structures of osteolytic areas are demonstrable radiographically. Diagnosis is established by mandatory histological examination of sinus tracts. Amputation or exarticulation of the extremity involved including efferent lymphatic vessels and nodi has no alternative. Local measures are insufficient. Apparently the first 3 years are decisive as to the prognosis. The prophylaxis consists of the therapy of the original disease: radical debridement of the osteomyelitic focus and filling of the defect with autogenous cancellous bone grafts.
Insights
Malignant degeneration of chronic osteomyelitis sinus tracts is underestimated and can occur in any patient. Early diagnosis via histology and radical treatment, including amputation, are crucial for prognosis.
Area of Science:
- Orthopedics
- Oncology
- Dermatology
Background:
- Malignant degeneration of skin ulcers is known since 1884.
- The risk of malignant transformation in chronic osteomyelitis sinus tracts remains underestimated.
- This complication can affect any skeletal site, age group, and duration of disease.
Purpose of the Study:
- To highlight the underappreciated risk of malignant degeneration in chronic osteomyelitis sinus tracts.
- To emphasize the diagnostic and therapeutic challenges associated with this condition.
Main Methods:
- Review of historical data and clinical observations.
- Emphasis on radiographic and histological diagnostic criteria.
- Discussion of treatment outcomes and prognostic factors.
Main Results:
- Malignant degeneration is not limited by patient age or disease duration.
- Clinical signs include increased tenderness and purulation.
- Radiography may show "washed out" osteolytic areas.
- Histological examination of sinus tracts is mandatory for diagnosis.
Conclusions:
- Radical treatment, including amputation and lymph node dissection, is often the only effective option.
- Local treatments are insufficient.
- Prognosis is significantly influenced by the first three years post-diagnosis.
- Prophylaxis involves radical debridement of the osteomyelitic focus and bone grafting.