The goal of treatment is to eliminate the draining sinuses and produce a functional limb that is free from pain. The complicated process just described to eradicate a focus of osteomyelitis is very expensive and time consuming. In some patients, amputation of the infected part may be the most reliable and effective way of restoring a pain-free and productive life.

DELAYED POSTTRAUMATIC OSTEOMYELITIS IN DIABETIC PATIENT

Infection in a diabetic patient can be aggressive and life threatening (see Plate 8-9). Infections often develop around skin ulcerations in the foot. The patient’s impaired immune system allows the infection to ascend rapidly into the leg. Even after an aggressive soft tissue infection has been controlled, foot ulcers may persist. The ulcers continue to drain, and the lack of soft tissue coverage over the bone exposes it to chronic irritation and the continued risk of infection. It is therefore important to try to achieve and maintain soft tissue coverage of such ulcerated areas.

The first step in the treatment of osteomyelitis associated with diabetes is extensive debridement of the necrotic tissue and removal of any underlying sequestra. When the necrotic, infected tissue has been removed, wet-to-dry dressings are applied to stimulate the formation of granulation tissue; hyperbaric oxygen therapy can further stimulate the development of a granulation tissue bed. Transplantation of vascularized tissue from other regions of the body (e.g., a vascularized omental graft) can also be performed to bring additional blood supply to the area to facilitate healing. Once a complete bed of granulation tissue develops, the defect can be covered with a split-thickness skin graft.