Treatment of osteomyelitis by closed continuous saline suction-irrigation

ABSTRACT

A total of 110 patients, aged 4 to 65 years, mean 22.4 years, 82 males and 28 females, were treated. The osteomyelitis was post-traumatic in 26 and haematogenous in 84. Of the traumatic cases, 20 followed operations on closed fractures. The disease had started 6 months to 27 years, mean 5.4 years, before treatment. The surgical technique included thorough debridement of soft tissues and excision of sinus tracks and fibrous tissue. The osteomyelitic cavity was treated by one of three procedures either a] deroofing, saucerisation and sequestrectomy, b] large bored drilling of its walls, or c] packing with cancellous pelvic bone graft after saucerisation and sequestrectomy. This was followed by continuous suction-irrigation by saline circulating hi plastic tubes inserted at the end of the operation. The wound was tightly closed in layers. The irrigation was continued for 7 to 52 days, mean 22.7 days. Antibiotics were started from the first day of the operation. They were chosen properly according to the sensitivity of the microorganisms cultured aerobically and obtained by swabs from discharging sinuses and from the depth of the osteomyelitic cavity. They grew mostly Staphylococcus aureus [101 cases], either alone [79 cases], or with Staphylococcus epidermidis, Gram positive cocci, diphtheroid bacilli, Escherichia coil, Pseudomonas, haemolytic Bacillus subtilis. The results were clinical cure of the bony and soft tissue disease in 82 cases [74.5%] for all the period of follow-up of 7 to 11 years. Ten more cases [9.1%] were also cured for 7 to 11 years, but had delayed soft tissue healing up to 6 weeks. Of the remaining 18 cases [16.4%] considered as failed, 9 recurred in the first 2 months due to failure of the irrigation system. The other nine cases recurred later within 2 years. Of these 18 cases, 9 could be reoperated, using the same techniques and remained cured. The other 9 refused treatment or vanished