[Bone grafting in the treatment of hematogenic osteomyelitis]

A qualitatively new method is introduced, developed and established in practice on the ground of clinical experience with 44 patients with hematogenic osteomyelitis. Thus the idea about "osteoplastic treatment of osteomyelitis" is adopted. Bone transplantation is the basic and dynamic factor of this type of management. Contrary to traditional concepts the author's clinical experience shows that successful bone grafting is possible provided all specific requirements are met, namely radical removal of the purulent-necrotic substrate, presence of regeneration potential in the recipient bed, creation of favourable conditions for wound healing by first intention, and active struggle against infection as a permanently acting factor, and in case it is already present. The bone transplant in addition to promoting elimination of the osteomyelitic bone defect, which is the primary pathogenic factor of chronic pus discharge, contributes also to the cure of the basic process in the course of its dynamic interaction with the recipient bone. Bone auto-, allo- and xeno (calf)-grafts are used as transplantation material. The indications for osteoplastic treatment, the surgical policy, operative technique and operative procedures are presented. The proposed original operative methods of osteoplastic management are submitted schematically and illustrated by single case reports. Complete cure as the result of osteoplastic treatment alone is attained in 388 cases or 87.3 per cent out of the total number of 444 patients. In the remaining 55 cases in whom the treatment failed, reoperation was performed because of residual foci, complications on behalf of the graft (sequestration), persistent fistulae or skin defects, resulting in the cure of fifty of them. Here too, the attained result is attributable to the osteoplastic treatment. Hence out of the total number of 444 patients operated on a cure is achieved in 434 cases or 97.7 per cent. After comparative evaluation of the quality of bone graft a net preference is given to cancellous autografts. A transplant taken from the iliac crest is considered as the optimal quality one. Regarding massive bone grafts, auto- or allogenous alike, a rather elevated sequestration rate is recorded, 10 and 33 per cent respectively. A particular importance is ascribed to the regenerative qualities of the recipient bed. Results recorded among children are superior. In patients free of fistulae the rate of cures is 19.3 per cent higher in patients with fistulae.