RESUMEN
High-energy penetrating extremity injuries are often associated with severe open fractures that have varying degrees of soft-tissue contamination and tenuous soft-tissue coverage. The result is a relatively high prevalence of chronic osteomyelitis compared with that in civilian trauma patients. Diagnosing chronic osteomyelitis requires a careful history and thorough physical and radiographic examinations. Cross-sectional imaging can help delineate the extent of bony involvement, and scintigraphy can be used as a diagnostic tool and to gauge response to treatment. Clinical staging also directs surgical management. Adequacy of débridement remains the most important clinical predictor of success; thus, adopting an oncologic approach to complete (ie, wide) excision is important. Reconstruction can be safely performed by a variety of methods; however, proper staging and patient selection remain critical to a successful outcome. Although systemic and depot delivery of antibiotics plays a supporting role in the treatment of chronic osteomyelitis, the ideal dosing regimens, and the duration of treatment, remain controversial.
Asunto(s)
Antibacterianos/uso terapéutico , Desbridamiento/métodos , Diagnóstico por Imagen/métodos , Infección de Heridas , Enfermedad Crónica , Humanos , Pronóstico , Índice de Severidad de la Enfermedad , Infección de Heridas/clasificación , Infección de Heridas/diagnóstico , Infección de Heridas/terapiaRESUMEN
Failure of an acute inflammatory response to resolve a wound infection heralds a cascade of events that affects the host and pathogens, culminating in a chronic, refractory condition. The factors contributing to this outcome include immune compromise of the host, antimicrobial resistance, wound-healing deficiencies, and the adherence of pathogens to themselves and wound surfaces via an impenetrable, resistant biofilm. To eradicate chronic infection, the pathogens, biofilm, surfaces available for adherence, and compromised tissue must be removed.
Asunto(s)
Antibacterianos/uso terapéutico , Desbridamiento/métodos , Infección de Heridas/tratamiento farmacológico , Heridas Penetrantes/cirugía , Enfermedad Crónica , Humanos , Resultado del Tratamiento , GuerraAsunto(s)
Enfermedades Óseas Infecciosas/prevención & control , Procedimientos Ortopédicos , Infección de la Herida Quirúrgica/prevención & control , Enfermedades Óseas Infecciosas/diagnóstico , Enfermedades Óseas Infecciosas/etiología , Humanos , Procedimientos Ortopédicos/efectos adversos , Procedimientos Ortopédicos/métodos , Infección de la Herida Quirúrgica/diagnóstico , Infección de la Herida Quirúrgica/etiologíaRESUMEN
Chronic osteomyelitis is refractory to nonsurgical treatment due to a resilient, infective nidus that harbors sessile, matrix-protected pathogens bound to substrate surfaces within the wound. Curative treatment mandates physical (surgical) removal of the biofilm colony, adjunctive use of antibiotics to eliminate residual phenotypes, and efforts to optimize the host response throughout therapy. Patient selection, therapeutic options, and the treatment format are determined by the Cierny/Mader staging system, while reconstruction is governed by the integrity/stability of the affected bone(s) and quality/quantity parameters of the soft-tissue envelope.