Treatment of chronic osteomyelitis requires removal of all infected, necrotic bone and all metal foreign bodies; debridement of all necrotic soft tissue; and marsupialization of the necrotic, infected bed. Stability of the limb can often be maintained with the use of an external fixation device that bridges the area of infection (see Plate 8-7). Repeated debridement is often necessary to ensure that all the infected, necrotic tissue is excised. Tissue samples should be obtained from the depths of the wound and cultured to determine the appropriate antibiotics. Antibiotics are then administered intravenously until the wound heals. Between debridements, the wounds are packed open; dressings are changed daily to remove any residual necrotic material while encouraging the development of granulation tissue in the base of the wound. Some researchers recommend the use of hyperbaric oxygen as a supplement to this treatment regimen. Hyperbaric oxygen therapy enhances the function of leukocytes and promotes the growth of granulation tissue.
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