Primary wound closure in chronic osteomyelitis

The sequelae of chronic osteomyelitis include not only the common clinical and radiographic signs and symptoms unique to it, but also the frequent residual deformity or amputation secondary to surgical intervention. Exacerbations and relapses are common and may occur as a result of trauma or a decrease in the resistance of the patient. Treatment of this condition over the years has been controversial. Some authors (1, 2) advocate treatment with high oral doses of antibiotics over a period of time up to 6 months. Although good results have been obtained with this regimen, other factors must be taken into account before initiation of such therapy such as severity and location of infection, drug allergy, renal and hepatic function, and attainable antibiotic blood levels. However, because of thrombosis of nutrient, marrow, and periosteal blood vessels, along with fibrosis of surrounding soft tissue, there is no guarantee that adequate serum antibiotic levels provide for the minimal inhibitory concentration of the drug in the infected bone. Antibiotic therapy without surgical intervention to improve blood supply cannot cure the disease and may result in an acquired resistance by the organism (3). The most widely accepted treatment today is surgical curetment, sequestrectomy, or resection of the infected osseous tissue with extensive debridement of all sinus tracts and devitalized tissues. Adding to the morbidity of this disease is the excessive scarring produced by inadequate and improper wound closure after surgical intervention. The following is a description of several methods utilized for contaminated wound closure.