Chronic osteomyelitis management in austere environments: the International Committee of the Red Cross experience.

BACKGROUND: Chronic osteomyelitis (COM) causes major physical disability. In situations of limited resources and war zones, western world treatments are neither affordable nor sustainable. The International Committee of the Red Cross has established a COM treatment project in the Democratic Republic of Congo, with emphasis on affordability and sustainability. METHODS: One hundred and sixty-eight patients were treated for COM. The protocol focused on surgical excision of necrotic bone, physiotherapy and an open wound dressing method using granulated brown sugar. RESULTS: Seventy-one patients could be reviewed with a mean follow-up of 13.7 months (5-28 months). 46 patients (63.4%, 95% CI 52.5-75.6) had excellent/good results in terms of clinical cure of the infection, and 36 patients (50.7%, 95% CI 38.7-62.7) had seen excellent/good improvement in their functional status compared with before treatment. CONCLUSIONS: The above-mentioned treatment protocol has shown encouraging results: almost two-thirds of the patients had their infection clinically cured, and half the patients saw significant functional improvement.