Malignant Transformation in Chronic Osteomyelitis

Abstract

Malignant transformation as a result of chronic osteomyelitis represents a relatively rare and late complication with a declining incidence in the modern world. For most patients, the interval between the occurrence of the original bacterial infection and the transformation to malignant degeneration is several years. The diagnosis of malignant transformation in a chronic discharging sinus requires a high index of clinical suspicion. Wound biopsies should be obtained early, especially with the onset of new clinical signs such as increased pain, a foul smell, and changes in wound drainage. Squamous cell carcinoma is the most common presenting malignancy. Definitive treatment is amputation proximal to the tumor or wide local excision, combined with adjuvant chemotherapy and radiation therapy in selected patients. Early diagnosis may sometimes allow for treatment consisting of en bloc excision and limb salvage techniques. However, the most effective treatment is prevention with definitive treatment of the osteomyelitis, including adequate débridement, wide excision of the affected area, and early reconstruction.

In vitro and in vivo drug release and antibacterial properties of the novel vancomycin-loaded bone-like hydroxyapatite/poly amino acid scaffold

“…However, the recurrence rate is high, reportedly up to 30% at 12 months after surgery. 15 The involvement of biofilm in the infection is related to the diversity of clinical symptoms observed in chronic osteomyelitis and the variability in the course of the disease. 16 Generally, necrotic tissue including sequestrum induces the formation of biofilm because necrotic tissue takes the form of a foreign body in vivo and becomes infected by bacteria.…”

Chronic osteomyelitis: what the surgeon needs to know

“…12 Surrounded by the biofilm, these pathogens present with an altered phenotype with regards to growth, gene expression and protein production 2 that protects them from the host’s defence mechanisms and the systemic effect of antibiotics. 3,19 This is in contrast to the initial infectious phase where the bacteria are still in a planktonic phase, having a high metabolic and generational rate, a factor that increases their sensitivity to common antibiotics. 19 The pathogens can remain in this state for long periods of time and can cause flare-ups many years after the initial inoculation.…”

“…3,19 This is in contrast to the initial infectious phase where the bacteria are still in a planktonic phase, having a high metabolic and generational rate, a factor that increases their sensitivity to common antibiotics. 19 The pathogens can remain in this state for long periods of time and can cause flare-ups many years after the initial inoculation.…”

“…27 Local flaps including muscle flaps, pedicled muscle flaps, myocutaneous flaps and osseous flaps have been used to optimise the impaired soft tissue envelope, with good results. 6,19,20,28 . Vascularised free flaps have also been used to cover large defects where the local tissues are impaired.…”

“…Vascularised free flaps have also been used to cover large defects where the local tissues are impaired. 6,19,20 …”