Osteomyelitis is an infection frequently caused by bacteria in the bone, depending on the cause it can occur in any region of the body and neglect and failure to treat in time can lead to very serious and unwanted complications.
Osteomyelitis requires prolonged antibiotic therapy, taking weeks to months. For this purpose, a central intravenous line is often placed. Osteomyelitis may also require surgical debridement. Severe cases can lead to the loss of a limb. First-line antibiotics of choice are usually glycopeptides such as vancomycin, determined by the patient's history and regional differences in respect of infectious organisms. Rifampicin and tetracyclines may also be used.
In 1875, American artist Thomas Eakins performed a surgical procedure for osteomyelitis at Jefferson Medical College in a famous oil painting entitled The Gross Clinic.
Prior to the availability and use of antibiotics, deliberately introduced fly larvae were used in wounds to feed on infected materials, and were generally effective in cleaning the wound.
Hyperbaric oxygen treatment has been shown to be a useful adjunct to the treatment of refractory osteomyelitis. A number of institutions indicate treatment lasting 42 days.
Not long ago, after a laborious and interesting surgery we had to amputate the fifth toe of a foot after a bone to which it is attached called "metatarsal" suffered an infection of great proportions.
But I'm sure you're wondering... Why amputate and not treat with strong antibiotics?
It turns out that osteomyelitis unlike other infections, such as in the skin for example, its treatment does not completely eliminate the infection because the bacteria are protected from a strong film or wrapping layer when they reach the bone, so the conventional treatment needs to change to radical treatment (so pay close attention to those simple skin infections that inadvertently become a big problem).
What about surgery?
For the amputation of the fifth metatarsal and toe, it is necessary to perform a so-called "racket approach" and after the foot is meticulously reconfigured with four toes is followed until it is reintegrated and performs its activities but this time with special footwear. This surgery is called: "cosmetic foot reconstructive surgery".
Complications of osteomyelitis may include the following:
Bone death (osteonecrosis). An infection in the bones may prevent blood from circulating within the affected bone, which can lead to bone death. The bone may heal after surgery to remove small parts of the dead bone. However, if most of the bone has died, you may need surgery to have your limb removed (amputated) to prevent the infection from spreading.
Septic arthritis. In some cases, infection inside the bones can spread to a nearby joint.
Impaired growth. In children, the most common location of osteomyelitis includes the softer areas, called "growth plates," which are located at either end of the long bones of the arms and legs. Normal growth may be disrupted in the infected bones.
Skin cancer. If osteomyelitis has resulted in a pus-secreting sore, the surrounding skin has an increased risk of developing squamous cell carcinoma.
If you need recommendations or help in orthopedic surgery and traumatology do not hesitate to contact me.
Dr. Leopoldo Maizo - Orthopedic Surgeon
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