Management of chronic osteomylitis by wide debridement and closed suction: Drainage technique

Abstract

Background: Chronic osteomyelitis remains one of the most challenging problems in orthopaedic surgery [1-6]. It commonly occurs after sequele of acute osteomylitis in children and teenagers, secondary osteomylitis due to trauma involving either an open fracture or internal fixation [1]. Materials & Methods: This is prospective longitudinal study. We have prospectively studied 98 patients with chronic osteomyelitis treated by the technique of wide debridement and closed suction and drainage and describe the results at a mean follow-up of 21.96 months (min-max 20 to 24; median 22). The procedure involved radical debridement and excision of all avascular scarred and infected granulation tissue, followed by debridement of the infected endosteum, reaming and the insertion of closed suction drainage system. The system rely on rapid fluid flow of 5 ml 10% povidon iodine in 500 ml normal saline and mechanical washing in association with appropriate intravenous antibiotic. The fluid used for drainage is normal saline and mixture of 5 ml 10% povidon iodine in 500 ml normal saline. Results: Healing was achieved in all patient with fractures which had not previously united. There were three cases with recurrent infection with this procedure. Three patients required below-knee amputation due to eradication of the infection. These three patient had post traumatic osteomylitis. The mean follow-up was for 21.96 months (min-max 20to24; Conclusions: The procedure of wide debridement and closed suction drainage is indicated for complex cases of osteomyelitis in which conventional surgical debridement have failed. Introduction Chronic osteomyelitis remains one of the most challenging problems in orthopaedic surgery [1-6] It commonly occurs after sequele of acute osteomylitis in children and teenagers, secondary osteomylitis due to trauma involving either an open fracture or internal fixation [1] The event which heralds the transition from acute to chronic osteomyelitis is bacterial attachment to a functionally inert non-resorbable substratum, either a sequestrum or a foreign body [7]. In chronic osteomyelitis infected, dead bone lies within a compromised soft-tissue envelope [8]. Many regimes have been proposed for the treatment of chronic osteomyelitis including antibiotics [9-12] , debridement and en-bloc excision [1, 13] , staged management [14] ,closed irrigation and suction drainage [15-21] initially described by Smith-Petersen et al [20] in 1945, open bone grafting [2, 22-28] and mayoplasty [14, 29-31]. The procedure involved radical debridement and excision of all avascular scarred and infected granulation tissue, followed by debridement of the infected endosteum, reaming and the insertion of closed suction drainage system. The system rely on rapid fluid flow of 5 ml 10% povidon iodine in 500 ml normal saline and mechanical washing in association with appropriate intravenous antibiotic. The fluid used for drainage is normal saline and mixture of 5 ml 10% povidon iodine in 500 ml normal saline.