Osteomyelitis Surgical Treatment

What is it?

Surgeons must plan specific treatment for each patient, because host morbidities often play an important role in propagation of infection. Team approach is mandatoryinvolving orthopedic and plastic surgery, as well as infectious disease.In fact treatment requires isolation of the pathogens, aggressive debridement for removal of all infective and necrotic material, and then bony and soft tissue reconstruction.

Technical difficulty:
Medium for surgical debridement. High for local flaps reconstruction. Tecnically demanding and significantly high for free flaps reconstruction
Average duration of the intervention:
1 to 2 hours for surgical debridement, up to 3 hours when local flaps reconstruction is required; up to 4 to 5 hours when free flap reconstruction is required
Average duration of hospitalization:
7 up to 10 days

When is this procedure indicated?

Indications for surgery include antibiotic failure, infected surgical hardware and chronic osteomyelitis with necrotic bone and soft tissue.

How is it performed?

Aggressive and effective debridement is aimed at removing all infected or necrotic bone and soft tissue in a single or staged fashion. Techniques are similar to those used for cancer surgery. Debridement must obtain margins in normal healthy bleeding tissue. Larger osseous defects require bone for stability and can be managed with a vascularized free fibula flap. An alternative to vascularized bone grafts involves distraction osteogenesis with Ilizarov technique. Single-stage  bone  excision  and  soft  tissue  reconstruction should  be  undertaken  whenever  possible  as  early  coverage is associated with earlier union, reduced infection, and shortened  hospitalization. Local and free flaps can both be used for soft-tissue loss management depending on size and site to cover. Free flaps are transplanted to the recipient area and their ciculation re-estabilished connecting recipient vessels with microsurgical technique under microscope magnification . This is in contrast to a "pedicled" flap in which the tissue is left partly attached to the donor site ("pedicle") and simply transposed to a new location.


Full recovery is espected one to two months after surgery. A minimum follow-up period of 2 years would reveal over 90% of the recurrences. Late ‘recurrences’ may represent new infections, rather than reactivation of previous infection.

Short-term complications

Depend on the type of procedure. These include, but are not limited to, bleeding, seroma, infection, fluid collection, poor healing. Flap surgery includes the risk of partial or complete loss of the flap.  Osteomyelitis is a difficult-to-cure infection with a high relapse rate despite combined medical and surgical therapies.

Long-term complications

Late ‘recurrences’ may represent both new infections and, rarely, reactivation of previous infection.

Are you interested in receiving the treatment?

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