[Treatment of extensive post-traumatic osteomyelitis of the long bones]

The principles of active surgical treatment of extensive posttraumatic osteomyelitis of the long bones made it possible to restore the anatomical and functional intactness of the affected extremities in 92 patients within a short time. All the patients were admitted from other medical institutions because the previous treatment was inefective. The developed therapeutic method consisted of the following main components: surgical debridement of the purulent focus with removal of all nonviable tissues; adequate immobilization of the bone fragments with apparatuses of external fixation; early restorative plastic operations; general intensive measures. The large wound surfaces were closed and the defects in the tissues were repaired by various plastic operations. Free dermatoplasty was performed in 38 patients, plastics with local tissues in 39, dosed soft tissue stretching in 19, plastics with a full-thickness graft on a nutrient supplying pedicle in 19, free plastics with a complex of soft tissues by means of microsurgical techniques in 6 patients, and different variants of compression-distraction osteosynthesis for repair of the bone defects were applied in all 92 patients. The results were satisfactory and good in 98.9% of cases. In 2 cases, which were not included in the group of discussed patients, amputation of the extremity was conducted immediately after admission because gangrene had developed.