Principles of the therapy of bone infections in adult extremities

Abstract

Septic diseases of the bone and immediately surrounding soft tissues can be differentiated into osteitis or osteomyelitis. Both are a most serious diagnosis in modern traumatology and orthopaedic surgery. The basis for treatment is a highly specific, problem-adapted therapy with a defined strategy, the paramount goal being to preserve the stable weightbearing bones, maintain a good mechanical axis with correctly working muscles and joints, and avoid permanent disability. “State-of-the-art” therapy of osteitis and osteomyelitis has two priorities: (a) Eradication of the infection; (b) Reconstruction of bone and soft tissue. Surgical treatment with resection of the affected bone segments and soft tissue, followed by reconstructive methods continues to be the main basic therapy, and is supported by local and systemic antibiotics and adjuvant methods such as hyperbaric oxygen. This article provides an overview of the diagnostic features and different surgical procedures as well as the current literature in order to reach the above named goals.

Evaluation and Comparison of the Effects of Hyperbaric Oxygen and Ozonized Oxygen as Adjuvant Treatments in an Experimental Osteomyelitis Model

“…Osteomyelitis is an extremely serious diagnosis in modern trauma and orthopedic surgery [1]. Treatment of osteomyelitis is complex and difficult and requires a multidisciplinary approach [2].…”

Effects of Local Antibiotic Delivery from Porous Space Maintainers on Infection Clearance and Induction of an Osteogenic Membrane in an Infected Bone Defect

“…27 Infection is a complicating factor in this technique, and local delivery of antibiotics adds yet another layer of complexity to the membrane, as both infection and antibiotic treatment can affect local cell populations. IL-1b, IL-6, IL-10, and TNFa are immensely important cytokines in bone regeneration and homeostasis and are well-known modulators of the inflammatory response to implanted biomaterials, thus the temporal expression of these molecules is critical.…”

Reconstruction of Heel Defect Occured by Verrucous Carcinoma

“…The most common location of verrucous carcinoma is the oral cavity, and extra-oral sites such as the genitalia, but is rare on the foot. Verrucous carcinoma is often related to skin infection 8 ; thus, it is essential to obtain a complete history to assess host risk factors, and wound healing 9 . Because of thin skin and subcutaneous tissue, and small foot muscles, focal carcinoma lesion is often complicated by local infection 10 .…”