Chronic osteomyelitis, although treated medically and surgically, often recurs within
less than 2 years because of numerous sequelae including poor blood supply, residual
dead space and resistant micro-organisms. Recovery from this disease essentially involves
the following treatment approaches: 1) long-term administration of various antibiotics;
and 2) effective surgery. Antibiotic treatment will not prove successful until dead,
osseous, and soft fibrotic tissue excision is complete. Meanwhile, wide debridement
of the wound and fibrotic tissue excision makes direct closure of tissue unfeasible.
Currently, rotational and free flap procedures make direct closure of wounds possible
after complete debridement and removal of soft fibrotic tissue.
Clinical experience in the last 10 years indicates the success of these techniques
in treatment of upper and lower limb osteomyelitis following, mitigation of sequelae
along with antibiotic therapy. The remarkable effectiveness of vascularized flaps
accounts for increased blood supply, more oxygen, and defense mechanisms in the infected
area. To manage upper limb osteomyelitis, rotational musculocutaneous flaps followed
by vascularized free fibula have been relatively successful. However, for the lower
limb, musclular or musculucutaneous free flaps have been more effective. The various
management and treatment protocols in chronic osteomyelitis by rotational, island,
and free flap procedures were presented.
