Results of open wound technique in the treatment of post-sequestrectomy dead space
1Department of Orthopaedics and Traumatology, College of Medicine, Ambrose Alli University, Ekpoma, Nigeria.
Insights
Open wound treatment of dead spaces after osteomyelitis surgery in children showed better healing and lower recurrence rates. This method is recommended for resource-limited settings, despite longer healing times.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Pediatric Medicine
Background:
- Chronic osteomyelitis remains a significant challenge in developing nations, particularly in children.
- Optimal treatment strategies for post-sequestrectomy dead spaces are not well-established.
- Haematogenous chronic osteomyelitis of the tibial shaft presents variable outcomes.
Purpose of the Study:
- To prospectively evaluate wound healing and recurrence rates after open wound treatment of post-sequestrectomy dead spaces.
- To compare the outcomes of open wound treatment versus closed wound technique in pediatric chronic osteomyelitis.
- To assess the efficacy of open wound management in resource-poor settings.
Main Methods:
- Prospective evaluation of 30 pediatric patients with tibial shaft osteomyelitis undergoing open wound treatment.
- Comparison with a control group of 30 similar patients treated with closed wound technique.
- Surgical procedures included saucerization, sequestrectomy, and curettage, with wounds left open or closed.
- Standard perioperative management and chi-square test for statistical analysis were employed.
Main Results:
- Staphylococcus aureus was the most common pathogen identified.
- The open wound treatment group demonstrated significantly better rates of wound healing and lower recurrence rates compared to the closed wound group (p<0.05).
- While the open method resulted in a longer healing period, the overall outcomes were superior.
Conclusions:
- Open wound treatment of post-sequestrectomy dead spaces yields favorable outcomes in pediatric chronic osteomyelitis.
- This approach is particularly beneficial and recommended for resource-limited settings.
- Further research may explore optimizing healing times for the open method.
Background And Method:
Severe chronic osteomyelitis with variable outcomes is still common among children in developing nations. There has been no consensus on the optimal method of treatment. We therefore prospectively evaluated the rates of wound healing and recurrence following open wound treatment of post-sequestrectomy dead spaces in 30 patients with haematogenous chronic osteomyelitis of the tibial shaft at the King Orthopaedic Clinic, Ekpoma, Edo State, Nigeria, between January 2001 and December 2005. Thirty similar patients whose post-sequestrectomy dead spaces were treated by closed wound technique formed the control group. Both groups were subjected to standard methods of perioperative management. Saucerisation, sequestrectomy and curettage were the cornerstones of surgical therapy. The wounds were primarily either left open (study group) or closed (control group). The rates of wound healing and recurrence were used to assess the outcome of treatment. The chi-square test was used for statistical analysis.
Results:
The median age was 13 years, with a range of 6 - 60 years. Staphylococcus aureus was the organism most commonly associated with chronic osteomyelitis. Rates of wound healing and recurrence in the study group were significantly better than in the control group (p<0.05), even though it took a relatively longer period to achieve healing with the open method of treatment. The follow-up period ranged from 1 to 5 years, with a median of 2 years.
Conclusion:
We observed that the results of the open method of treating post-sequestrectomy dead spaces were good, and we advocate its use in resource-poor settings.
