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[Surgical treatment of chronic osteomyelitis of the skull]
Yuangang Lu1, Ying Cen, Yong Qing
1Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, PR China.
Objective:
To summarize the treatment of chronic osteomyelitis of the skull and its effectiveness.
Methods:
Between January 2004 and February 2009, 24 patients with chronic osteomyelitis of skull were diagnosed and treated, including 16 males and 8 females with an average age of 45.6 years (range, 18-56 years). The mean disease duration was 5.8 years (range, 3-11 years). The causes included infection after craniotomy in 3 cases, burn in 15 cases, and electrical injury in 6 cases, and the lesion was located at the frontal and parietal of the skull in 10 cases, at the temporal and parietal of skull in 8 cases, and at the occipital of the skull in 6 cases. The soft tissue defects ranged from 7 cm x 6 cm to 19 cm x 12 cm, and the skull defects ranged from 5 cm x 4 cm to 10 cm x 7 cm. After wide thorough debridement of necrotic tissue, soft tissue defects were repaired with adjacent scalp flap in 12 cases, trapezius myocutaneous flap in 6 cases, and free anterolateral thigh flap in 6 cases; the flap size ranged from 8 cm x 7 cm to 20 cm x 13 cm. The donor sites were sutured directly or covered with split-thickness skin.
Results:
All pathological examinations showed pyogenic osteomyelitis of the skull, and localized squamous carcinoma was found in 1 case. One patient had sub-flap infection at 2 weeks after operation, and healing was achieved after surgical removal of residual tissue; the remaining flaps survived, and incision healed by first intention. All patients were followed up 10 months to 4 years with an average of 2 years after operation. The color and texture of the flaps were good. No recurrence of osteomyelitis happened during follow-up. The patient diagnosed as having localized squamous carcinoma was followed up 4 years without recurrence. At 3 to 6 months after operation, 8 patients had headache or felt dizzy, and the skull was reconstructed by the titanium meshes.
Conclusion:
In patients with chronic osteomyelitis of skull, the infected foci should be cleaned out thoroughly as early as possible, and the skin flap or myocutaneous flap is used to repair the wounds, thus the good results can be achieved.
