The use of quantitative bacteriologic assessment of bone

The purpose of this paper was to examine whether quantitative bacteriologic assessment of bone is a reliable indicator of the adequacy of debridement of draining wounds involving bone. This is a retrospective review of 31 consecutive patients treated for draining posttraumatic/ surgical wounds involving bone. Nineteen patients met the necessary criteria and were included in the study. These patients underwent radical debridement of bone and soft tissue, intraoperative assessment of the debrided wound by rapid slide quantitative bacteriologic assessment, and closure with well-vascularized tissue. Clinical assessment of vascularity and rapid slide quantitative bacteriologic assessment of cancellous bone and soft tissue were the only prerequisites used in determining the appropriateness of wound closure in this study. At the time of most recent follow-up, none of the 19 patients had recurrent wound drainage. Two patients required a second procedure to partially elevate their flaps and drain recurrent soft-tissue infections. None of the patients had recurrence of bony infection. Seventeen patients who presented initially with fractures or osteotomies all had successful bone unions. This study demonstrates that the technique of rapid slide quantitative bacteriologic assessment of cancellous bone is a useful adjunct to surgical judgment and allows one to close draining wounds (frequently with complex wound closure options) with a high level of confidence.