Why would we surgically debride osteomyelitis?

SUMMARY: Osteomyelitis treatment has significantly advanced since the early years, dramatically impacting overall wound treatment. Debriding osteomyelitis can safely cut out infected tissues and bones to reduce infections.

Why would we surgically debride osteomyelitis?

Osteomyelitis forms 'sequestra', which are inflamed pockets of dead cortical bones. Therefore, osteomyelitis becomes challenging to treat due to 'sequestra' being avascular, which leads to high patient morbidity or mortality. Debridement, therefore, aims at reducing infection and improving patient function. Earlier surgical treatments of osteomyelitis included the scraping away of dead bones till they started bleeding. 

Relevance of debridement for osteomyelitis

The frequency of predisposing conditions such as peripheral vascular disease of diabetes mellitus proportionally increases the occurrence of chronic osteomyelitis. The improved diagnosis techniques such as sensitive imaging, bone scintigraphy, and magnetic resonance have enhanced the accuracy of diagnosis and ability of infection characterization. Despite long-term antibiotic and hyperbaric oxygen therapy, there is still a high post-treatment osteomyelitis reoccurrence rate. This calls for surgical debridement of osteomyelitis.

In the case of acute osteomyelitis, doctors would have to carry out osteomyelitis debridement to get rid of dead and damaged bone tissues. This procedure involved the surgeon cutting away damaged or dead tissues of the bone. While doing this, they also wash the wounds to remove any loose tissue. 

If the infection is severe and unresponsive to therapy, there are a few protocols to handle the infection.

There are two ways osteomyelitis debridement is approached. First, if the infection goes deep into the body or a bone has to be removed, general anesthesia will be administered before debridement. For infections closer to the skin surface, numbing the area with anesthesia would simplify the process. A sedative may be induced to keep you relaxed during debridement.

Even though osteomyelitis debridement is a promising procedure, it is still a challenge to eliminate osteomyelitis. It occurs that nearly 30% of patients who undergo this surgery will have a reoccurrence. This calls for multiple surgeries that will eliminate the infected or dead bones.

Procedures involved in debridement

·Draining the infected area

Before the doctor debrides the infection, he will first open up the wound location of the infected bones and drain any fluid or puss build-up resulting in the infection.

·Removal of the infected bone and tissue

In the debridement procedure, the surgeon will remove a bigger portion of the diseased bone and take a small portion of an infected host to ensure most of the bacteria is captured. If any surrounding tissue shows any infection symptoms, the surgeon will have to cut them out.

 .Restoring blood flow to the bone

Once the osteomyelitis debridement procedure is concluded, there might be some spaces left, and this will require additional bone or tissue to fill. These fillers could be skin or muscle obtained from healthier parts of your body.

·Extraction of foreign objects

In some cases, osteomyelitis debridement may involve the removal of foreign objects on your bones or joints. These could be screws or surgical plates used in prior surgeries and are near the infected area. 

·Replacement of cut bones

The most common procedure to replace removed bones is using grafts extracted from the hip or bone banks. Some antibiotic implants may be directly inserted into the bone during the grafting process to optimize the healing process.