Is wide resection necessary in cases of chronic osteomyelitis?

Treatment of chronic osteomyelitis is based on a series of principles such as surgical debridement, culture collection, dead space management, antibiotic therapy, and bone and soft tissue reconstruction. The type of debridement is still a matter of debate, and wide resection with margins similar to those used in musculoskeletal tumors has been accepted.

However, this procedure generates structural instability and the need for major bone and soft tissue reconstruction. A more measured resection reduces the need for subsequent reconstructions. It was recently published in the magazine Open bones and joints A study aimed to further demonstrate the results of measured resection in cases of chronic osteomyelitis.

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the study

Hey Stady It was a retrospective, single-center study based on patients operated on at Hull University Hospital in the UK between 2014 and 2020. Patients with chronic osteomyelitis were treated surgically by measured resection and with at least 12 months of treatment tracking was evaluated.

A total of 53 patients (54 bones) with a median age of 45.5 years (interquartile range 31 to 55) and tracking A median of 29 months (12 to 59) were included. In all, ten bones were of Cerny-Mader type I, 39 of type III, and five of type IV.

All patients were treated with single-stage therapy (planned in two stages for stabilization). Positive cultures grew by 75%. Overall, 46 cases (85%) of osteomyelitis were resolved after the initial procedure, and 49 cases (90.7%) were resolved at the last follow-up visit. Four patients (7%) underwent a second surgery and six patients (11%) developed complications.

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Conclusion

The study showed that with detailed preoperative evaluation and planning, even without wide resection, administration of a high concentration of antibiotics appears to provide results similar to radical debridement.