Osteomyelitis

Christopher J. Salgado, M.D. Lawrence B. Colen, M.D.

This issue of Seminars in Plastic Surgery is dedicated to osteomyelitis. At this point in time, there are nearly 18,000 referenced citations in the PubMed database that date back to the late 1800s when using “osteomyelitis” as a keyword. This number will undoubtedly rise as the days pass. The investigations and subsequent publications are by physicians and surgeons from all aspects of medicine who have encountered patients who suffer from the acute and chronic forms of this disabling disease. Although we may have an adequate understanding of the basic pathophysiology of the disease process and excellent staging systems that have allowed us to properly classify the disease, our therapy in combating osteomyelitis remains in its infancy.

It is our intent in putting together such an extremely talented and gifted group of collaborating scientists, physicians, and surgeons that the study of osteomyelitis will be better understood and that future investigations will be sought. Unlike funding for cancer in the United States and abroad, the study of osteomyelitis has little lobbying power for its investigative funds, although its surgical treatment may be considered at times similar. The importance of plastic surgery support in the investigation of this disease, not only in the reconstructive aspects but also in the therapeutic modalities, cannot be overemphasized.

In closing, I would like to thank the brilliant authors from varied disciplines and internationally recognized institutions that helped make this issue a significant reference tool for any physician and surgeon—the articles cover all aspects of osteomyelitis from diagnosis to treatment and reconstruction. I would also like to express my sincere gratitude to Dr. Larry Colen, who served as the consulting editor of this issue, for his mentorship and guidance.

Known since antiquity, osteomyelitis is a difficult-to-treat infection characterized by the progressive inflammatory destruction and new apposition of bone. In spite of the recent advances in surgical techniques, antibiotic pharmacology, biocompatible internal fixation devices, diagnostic modalities, and an improved understanding of the pathogenesis of osteomyelitis, the problem continues with more virulent bacterial infections each year.

The proper treatment of osteomyelitis depends upon numerous factors including its anatomic location, the presence or absence of foreign material or internal fixation devices, and the underlying comorbidities of the patient. The key to successful treatment is early detection and a multidisciplinary approach to its cure. Dr. Salgado has done a superb job in organizing this issue of Seminars in Plastic Surgery. In each article, authors who are experts in their fields highlight a specific management approach. They review the state-of-the-art approaches to the diagnosis as well as both the medical and surgical management of this all too common affliction. The treatment of both acute and chronic infections of bone, as well as their sequelae, is a complex, multidisciplinary challenge. This issue brings us all up to date with current theory, and Dr. Salgado should be congratulated.

To quote Jean-Martin Charcot, a French neurologist and professor of anatomic pathology: “Disease is very old and nothing about it has changed. It is we who change as we learn to recognize what was formerly imperceptible” (1879).