The treatment of osteomyelitis underlying pressure ulcers

Osteomyelitis is recognized as an often intractable hindrance to healing in the deep pressure ulcer. The mainstays of treatment of this disease have traditionally been surgical debridement followed by muscle flap revascularization, supplemented by antibiotic coverage. Hyperbaric oxygenation has also been shown to be effective in healing refractory osteomyelitis when used as an adjunct to surgical and medical therapy. This review defines the disease, and presents a current literature review and discussion of its treatment, including adequacy of debridement, options for wound closure, appropriate antimicrobial strategy, and the role of hyperbaric oxygenation. A short review of investigational modalities is also included.