Use of Topical Negative Pressure in the Treatment of Chronic Osteomyelitis

Abstract

The use of topical negative pressure is now an established practice among many surgeons for the treatment of difficult wounds, both as a frontline therapy and as a salvage procedure. Among difficult wounds, few present more of a challenge to the reconstructive surgeon than chronic osteomyelitis of the lower limb. Acutely, persistent sinuses and fistulas typically involve the whole length of the bone, necessitating extensive debridement that often results in extensive skin loss. Exposed bone and, frequently, exposed medullary cavities, leave a surface unsuitable for skin-grafting or conventional dressings. It is well recognized that the muscle flap is the optimal treatment following adequate debridement and antibiotic coverage. Despite an often initially excellent clinical result, some surgeons remain cautious about the long-term outcomes of treatment with either local or free flaps because of the recurrent nature of chronic osteomyelitis1,2. Treatment options for the lower limb are often further limited by the difficult anatomical constraints, making amputation always a possibility. We present a case of chronic osteomyelitis in a thirty-nine-year-old man who had recurrences, with failed skin grafts, pedicled flaps, and free flaps, over a period of more than thirty years. Topical negative pressure was used as a salvage procedure before a planned amputation. Following split-thickness skin-grafting, the wound healed and the patient had virtually full use of the limb for the next three years. The patient was informed that data from the case would be submitted for publication. We treated a thirty-nine-year-old man in whom acute hematogenous osteomyelitis of the left tibia had developed in 1963, when he was nine years old. At that time, he was treated with a cross-leg flap, but the infection recurred at the age of fourteen. Multiple debridement procedures and courses of antibiotic therapy were used until he …