Successful Truncated Osteomyelitis Treatment for Chronic Osteomyelitis Secondary to Pressure Ulcers in Spinal Cord Injury Patients

Abstract

Time-tested treatments for chronic osteomyelitis involve prolonged courses of costly antibiotic treatment. Although such treatment remains unquestioned in acute osteomyelitis, it is an excessive regiment for chronic osteomyelitis. With appropriate surgical debridement and careful operative care, antibiotic treatment can be truncated in diagnoses of chronic osteomyelitis. This study represents the clinical practice of the pressure ulcer management program at Rancho Los Amigos National Rehabilitation Center in dealing with this difficult problem. One hundred fifty-seven patients with similar pressure ulcer wounds were studied retrospectively. Three groups of patients with pathologic diagnoses of acute osteomyelitis, chronic osteomyelitis, and negative osteomyelitis were compared for (1) postoperative stay, (2) wound infection, (3) wound breakdown requiring reoperation, and (4) same-site ulcer recurrence. In all cases, shallow bone shavings were sent for diagnosis via histologic study, and deep shavings were also sent to ensure adequate bone debridement and microbiologic study. All ulcers were subsequently closed with muscle and/or myocutaneous flaps. The negative and chronic osteomyelitis groups were treated with 5 to 7 days of IV antibiotics, whereas the acute group underwent a full 6-week course according to bone bacteriological culture and sensitivity. There was no statistical difference between the chronic osteomyelitis group and the control (negative) osteomyelitis group with respect to postoperative stay (70 days for chronic group, 72.4 for control), wound breakdown rate (10.7% for chronic, 10.2% for control), or ulcer recurrence (1.8% for chronic, 4.1 for control). The acute osteomyelitis group incurred longer hospital stays, greater incidence of wound breakdown, and statistically significantly greater ulcer recurrence (78.6 days, 13.2% and 17.0%, respectively). In cases of pressure ulcer management with bony involvement, bone pathologic diagnosis of chronic osteomyelitis allows for a shorter antibiotic course with better results when the offending tissue has been adequately debrided and closed with viable tissue flap coverage, than simple long-term (4-6 weeks) antibiotic treatment. Because of the extreme contaminated nature of these wounds, if such therapy works in these patients, it may be applicable to chronic osteomyelitis in more varied contaminated surgical cases involving bone.

Targeted antibiotic delivery using low temperature-sensitive liposomes and magnetic resonance-guided high-intensity focused ultrasound hyperthermia

“…This results in both systemic and local infection to deeper tissues (e.g. bones) [5], thereby requiring long treatment (generally >6 weeks), resection of tissues, and emergence of drug resistance [6–8]. Although healing with antimicrobials alone is challenging but possible, therapeutic failure and adverse drug reactions due to prolonged use and relapse are still common [9].…”

Recurring pressure ulcers: Identifying the definitions. A National Pressure Ulcer Advisory Panel white paper

“…A literature search was performed on MEDLINE and EMBASE databases for key terms of “pressure ulcer recurrence,” “recidivism,” or “healed.” The literature search resulted in 22 references. Of those, 14 articles were chosen for literature review based on the overall topic of the paper with relationship to “healed” or “recurrent pressure ulcers.” The other eight references had one of the terms mentioned but were excluded because they did not relate to the overall topic and did not specifically use terms related to pressure ulcer healing. The authors of this white paper divided the 14 articles among themselves and created evidence tables.…”

“…A review of the literature and discussion with thought leaders in the area of pressure ulcers confirmed this lack of a standardized nomenclature . Regulatory bodies and payors require specific terminology for documentation, quality monitoring, and reimbursement .…”

“…A review of the literature and discussion with thought leaders in the area of pressure ulcers confirmed this lack of a standardized nomenclature. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Regulatory bodies and payors require specific terminology for documentation, quality monitoring, and reimbursement. 15 The current system used by payors and regulators has been developed independent of a scientific basis or formalized research.…”

The operative treatment of pressure sores in the pelvic region: A 10-year period overview

“…Similar to other authors, we have not observed a higher incidence of post-operative complications or recurrence in patients with chronic osteomyelitis. 9 This diagnosis was based on a radiographic studies and occasionally histopathology. We resected the bone in all cases until we reached viable, intact bone structure.…”