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Abstract: Osteomyelitis is an infection of bone tissue due to bacterial infection, and most adult osteomyelitis is caused by severe open trauma. The patient in this case was injured in a factory accident 20 years ago and had more than 10 surgeries on his lower leg. The reason for this visit was that the patient felt an increase in pus flow from the wound in recent months, and a physical examination and related tests were performed to confirm the diagnosis of osteomyelitis. He was treated with surgery and medication. The exudate continued to decrease after the operation, and the wound healed and recovered 6 months after the operation.
Basic information】Male, 53 years old
Disease Type】Chronic osteomyelitis
Hospital】The First Hospital of Harbin Medical University
Date of consultation】October 2021
Treatment plan】Surgical treatment (debridement surgery + calcium sulfate antibiotic bone cement filling) + medication (cefoxitin sodium for injection)
Treatment period】Inpatient treatment for nearly 40 days, with regular outpatient follow-up
Treatment effect】The postoperative exudate continued to decrease, and the wound healed 6 months after surgery.
I. Initial consultation
The patient was a male in his 50s, with gauze wrapped around his leg at the time of consultation. The patient reported that he was injured in a factory accident 20 years ago and had more than 10 operations on his lower leg, and had been changing the medication at home by himself after the operation, but the pus had increased significantly in recent months. After communicating with the patient, he was examined. The examination revealed that: after uncovering the dressing, a foul odor permeated the entire consultation room; the trauma in front of the patient’s calf penetrated deep into the bone marrow cavity and was filled with pus and dead bone. Although the trauma was serious, the patient’s knee joint and ankle could be moved without affecting the patient’s daily walking.
II. Treatment process
Since the patient did not want to amputate his leg and still wanted to continue the treatment, I took a local sample and the bacterial culture showed that the bacterium was Aspergillus chimaera, which was sensitive to most antimicrobials. After identifying the pathogenic organism, debridement treatment was started, which included the dead and sclerotic bone present in the trabecular cavity, as well as pus, infected tissue, and inflammatory scarring until fresh blood continued to seep from the cavity. After a total of three debridement procedures, no more dead bone or pus could be seen in the cavity, and calcium sulfate cement beads mixed with antibiotics were then implanted in the cavity. The wound was continuously changed after surgery, and was transferred to a local hospital after surgery to continue the change of medication, and antibiotics such as cefoxitin sodium for injection were given intravenously throughout the treatment period.
III. Treatment effect
After the 1st debridement, the patient could no longer see obvious dead bone and inflammatory necrotic tissue in the trauma cavity. After 2 more debridement surgeries, the drainage fluid was already bloody, and the 4th debridement surgery implanted antibiotic calcium sulfate bone cement beads. Postoperatively, as the bone cement gradually disintegrated, there was still exudate from the wound, and the exudate decreased significantly after 3 weeks of dressing changes. After discharge, he was transferred to a local hospital for continued dressing changes, and the wound healed and recovered well 6 months after surgery.
IV. Notes
We are glad that the patient’s open wound of more than 20 years was resolved through nearly half a year of treatment, but this does not mean that the patient can rest easy. The seemingly healed wound may open and flow again at any time, therefore, during the later treatment and observation, the condition of the wound should be paid attention to at all times, and if there is any local redness, swelling, pain, wound oozing and other abnormalities should be promptly followed up. On a daily basis, nutrition should be strengthened, and a nutritious diet with high protein and fiber is recommended, and fresh fruits and vegetables are recommended to enhance resistance. In addition, daily attention to rest, quit smoking and drinking and other bad habits that are not conducive to wound recovery.
V. Personal insight
Once osteomyelitis becomes chronic, it is difficult to cure, and the disease can last for years or even for life. Although chronic osteomyelitis is difficult to treat, it is not incurable. Broadly speaking, the treatment of chronic osteomyelitis mainly includes medication and surgery, with medication referring to sensitive antibiotic therapy and surgery aiming to remove lesions and dead bone, eliminate dead cavities, and improve local blood circulation. This patient’s last surgical application of antibiotic bone cement beads, an absorbable bone cement that disintegrates while slow-releasing antibiotics, achieved good results. In addition to the necessary treatment, the patient’s active cooperation is equally important, as the disease should be detected and treated early to minimize its impact.