Extract
The use of topical negative pressure is now an established practice among
many surgeons for the treatment of difficult wounds, both as a frontline
therapy and as a salvage procedure. Among difficult wounds, few present more
of a challenge to the reconstructive surgeon than chronic osteomyelitis of the
lower limb. Acutely, persistent sinuses and fistulas typically involve the
whole length of the bone, necessitating extensive débridement that
often results in extensive skin loss. Exposed bone and, frequently, exposed
medullary cavities, leave a surface unsuitable for skin-grafting or
conventional dressings. It is well recognized that the muscle flap is the
optimal treatment following adequate débridement and antibiotic
coverage. Despite an often initially excellent clinical result, some surgeons
remain cautious about the long-term outcomes of treatment with either local or
free flaps because of the recurrent nature of chronic
osteomyelitis1,2.
Treatment options for the lower limb are often further limited by the
difficult anatomical constraints, making amputation always a possibility.