Managing Chronic Osteomyelitis and Open Wounds: A Patient's Guide

Chronic osteomyelitis and open wounds?

Hello, Doctor.
My father is 58 years old and has a history of high uric acid and gout.
Several years ago, he underwent a procedure to remove bone screws from his calf, which left a wound approximately 1.5 cm in diameter (deep enough to expose bone) that has not healed.
Initially, he underwent two suturing surgeries, both of which were unsuccessful.
After bacterial cultures, he was diagnosed with chronic osteomyelitis and has been living with an open wound for many years.
During this time, we have consulted several different doctors, but the condition of the wound has not improved; it continues to have an odor and itchiness.
We are also very concerned that if the wound becomes infected, it could directly affect the bone.
Currently, we are only able to keep taking antibiotics and applying topical medications.
Could you please provide some care recommendations? Thank you!

Avery, 30~39 year old female. Ask Date: 2019/04/13

Dr. Shi Guozheng reply Orthopedics

If osteomyelitis is confirmed, surgical intervention to remove necrotic bone and perform bone grafting may improve the condition.
Additionally, hyperbaric oxygen therapy has been used for treatment, and antibiotic therapy is also necessary.

Reply Date: 2019/04/13

More Info

Managing chronic osteomyelitis and open wounds can be a complex and challenging process, especially when dealing with a long-standing issue like the one your father is experiencing. Chronic osteomyelitis is an infection of the bone that can occur after an injury or surgery, and it often leads to persistent open wounds that are difficult to heal. Here’s a comprehensive guide on how to manage this condition effectively.

Understanding Chronic Osteomyelitis
Chronic osteomyelitis typically arises from a previous injury or surgery, as in your father's case. The presence of a non-healing wound, especially one that is deep enough to expose bone, is a significant concern. The symptoms you mentioned, such as odor and itching, are indicative of ongoing infection and inflammation. It’s crucial to address these symptoms promptly to prevent further complications, including potential bone deterioration.

Importance of Medical Management
1. Antibiotic Therapy: Since your father has been on antibiotics, it’s essential to ensure that the prescribed antibiotics are appropriate for the specific bacteria identified in the culture. Sometimes, chronic infections require prolonged courses of antibiotics, and in some cases, intravenous antibiotics may be necessary. Regular follow-ups with an infectious disease specialist can help tailor the antibiotic regimen.

2. Wound Care: Proper wound care is vital for managing open wounds. This includes:
- Cleaning: The wound should be cleaned regularly with saline or an appropriate antiseptic solution to remove debris and reduce bacterial load.

- Dressing: Use sterile dressings that can absorb exudate and protect the wound from further contamination. Some advanced dressings, such as hydrocolloids or alginates, may promote healing by maintaining a moist environment.

- Debridement: If there is necrotic tissue present, surgical debridement may be necessary to remove dead tissue and promote healing. This should be done by a qualified healthcare professional.

3. Monitoring for Complications: Regular monitoring for signs of worsening infection, such as increased redness, swelling, or discharge, is crucial. If your father develops fever or systemic symptoms, it may indicate a more severe infection requiring immediate medical attention.

Surgical Options
In cases where conservative management fails, surgical intervention may be necessary. This could include:
- Bone Surgery: Procedures such as sequestrectomy (removal of necrotic bone) or even amputation in severe cases may be considered.

- Flap Surgery: In some cases, reconstructive surgery using local or distant flaps can help close the wound and promote healing.

Lifestyle and Supportive Measures
1. Nutrition: A well-balanced diet rich in protein, vitamins, and minerals is essential for wound healing. Nutritional support may be necessary, especially if your father has difficulty eating due to pain or discomfort.

2. Pain Management: Effective pain management is crucial for improving quality of life. This may include over-the-counter pain relievers or prescribed medications.

3. Physical Therapy: If mobility is affected, physical therapy can help maintain function and prevent complications related to immobility.

4. Regular Follow-ups: Continuous follow-up with healthcare providers, including orthopedic surgeons and wound care specialists, is essential to monitor the healing process and make necessary adjustments to the treatment plan.

Conclusion
Managing chronic osteomyelitis and open wounds requires a multifaceted approach involving medical management, proper wound care, potential surgical interventions, and supportive measures. It’s crucial to maintain open communication with healthcare providers and advocate for your father’s needs. If the current treatment plan is not yielding results, seeking a second opinion from a specialist in osteomyelitis or a wound care clinic may provide additional insights and options. Your father’s health and comfort are paramount, and with the right care, there is hope for improvement.

Similar Q&A

Managing Osteomyelitis: Antibiotic Use and Follow-Up Care

After experiencing an open fracture of the left calf that led to osteomyelitis, there have been no issues for three years. Recently, the area of the previous injury has developed a skin abrasion, with swelling and mild tingling sensations, possibly due to a bump or some other cau...

Dr. Shi Guozheng reply Orthopedics
CRP and ESR can be checked; the former is C-reactive protein and the latter is erythrocyte sedimentation rate. Both of these indicators are used to assess inflammation or bacterial infection. Antibiotics should be administered according to specific guidelines for medication use. ...

Preventing Osteomyelitis: Key Insights for Rheumatoid Arthritis Patients

Hello, Doctor! I am a 42-year-old patient with rheumatoid arthritis. Since the onset of my condition, my inflammatory markers (ESR) have consistently been above 9, which is quite high. As a result, I have undergone total knee and hip replacements. Unfortunately, on January 7 of t...

Dr. Shi Guozheng reply Orthopedics
The transmission route is usually through the bloodstream and is related to immunosuppressive medications. There is a possibility of recurrence. If there are implants or artificial joints in the body, antibiotics may be less effective in reaching the site. Prevention involves mai...

Managing Osteomyelitis After Knee Replacement: Risks and Solutions

Hello Dr. Lin! I underwent a knee replacement surgery on April 3rd last year, which led to an infection and osteomyelitis: ESR 70; CRP 5.35. I was hospitalized for treatment for six weeks in November last year, and upon discharge, my ESR was 33; CRP 1.68. After discharge, I retur...

Dr. Lin Gengxiao reply Orthopedics
1. The condition referred to as periostitis in the letter is likely a miscommunication; it should refer to a wound with prolonged poor healing accompanied by inflammation. 2. Due to the lack of detailed clinical information, it is difficult to determine the condition; however, ba...

Preventing Infection and Promoting Healing in Open Fracture Recovery

Hello Dr. Hong, I would like to ask about my husband, who was hit by a car a few days ago. He has open fractures of the tibia and fibula in both lower legs. His right leg has already undergone surgery yesterday, and a steel rod was inserted. The left leg has a more severe wound,...

Dr. Hong Ximing reply Orthopedics
Bilateral tibia and fibula fractures are quite serious. After surgery, it is important to cooperate with your attending physician, as their team will do their utmost to provide treatment. For detailed information regarding your condition, you should consult with your attending ph...