[One stage operation for dead space of pyogenic and tuberculous osteomyelitis]

Pyogenic and tuberculous osteomyelitis is known to have difficult surgical problems. Complete surgical excision of dead and grossly infected soft tissues and osseous structures frequently results in large defects. Hydroxyapatite filler has been used to pack osteomyelitic defects. Between 1984 and 1991 we have treated 6 foci in 6 patients: 4 males aged 61, 54, 47 and 26 and; 2 females aged 59 and 36 years. There were 3 cases of chronic osteomyelitis, and one each of acute osteomyelitis, tuberculous osteomyelitis, and Brodie's abscess. All were reviewed within a period of between 21 to 94 months postoperatively. The pathogens cultivated were Mycobacterium tuberculosis in case 2 and Staphylococcus aureus in case 3 and case 6. In other cases, cultures revealed no pathogens. The hydroxyapatite fillers were mixed with an antibiotic. In addition, in the last four cases the fibrin sealant and CaCl2-thrombin solution were mixed. The excavated bone defect was packed with this composite biomaterial. Neither closed irrigation/suction using antibiotic solution nor a cast was used. Antimicrobial therapy directed specifically to the deep tissue specimens, was administered to all patients. On examination, all of the foci had completely healed by the end of the follow-up period. The cure of pyogenic and tuberculous osteomyelitis is obtained from obliterating dead spaces, which prevent the survival of organisms. Hydroxyapatite is the biomaterial most compatible with human bone and is also suitable for obliterating dead space. The advantages of the fibrin sealant system are that defects can be packed without gaps. Thus, postoperative hematomas can be avoided. In addition, the antibiotic incorporated into the fibrin sealant is released more slowly from the concentrated fibrin than from hematomas. As a result, pathogens multiply more slowly in fibrin. From these findings, we believe that this new method is simple, can be performed safely in one stage, and offers satisfactory results.