An aggressive surgical approach to the management of chronic osteomyelitis

This is a review of 13 patients with chronic osteomyelitis treated at the author's institution using techniques similar to the management of giant cell tumors of bone. This included aggressive serial debridements and appropriate antibiotic coverage and subsequent bone-grafting or soft-tissue coverage procedures. The number of surgical procedures ranged from three to eight (average 4.2) and were performed every two to three days. Empiric antibiotics were started after cultures were taken at operation, and were changed to organism-specific therapy when culture results were available. Parenteral antibiotics were continued for a mean of five weeks (range, two to eight weeks) and seven of 13 patients received oral antibiotics for an additional two to six weeks after parenteral therapy. Bone grafting or muscle flaps or both were used in those patients with compromised structural integrity, or to fill created dead space and allow wound closure. In postoperative follow-up evaluation, none of the patients have had evidence for recurrent osteomyelitis (mean duration, 58 months; range, 27-89 months). This technique of serial operations with proper antimicrobial therapy, followed by bone grafting and local muscle flaps when needed, has led to excellent end results in the treatment of chronic osteomyelitis.