Osteomyelitis treatment related to pressure ulcers in the pelvis

Abstract

Introduction:Chronic osteomyelitis treatment related to pressure sores around the pelvis is complex and multidisciplinary.The combination of antibiotics, usually aimed at more than one microorganism, in addition to a surgical treatment would reduce the recurrence of infection.The goal of our work was to analyze the results in patients with chronic osteomyelitis associated  to pressure sores around the pelvis,being treated with debridement and then with a flap to cover the soft tissue defect. MethodA descriptive, retrospective study was carried out based on data obtained from review of medical records of those patients requiring surgical coverage of pressure sores, between October 2010 until February 2017, being surgically treated 15 patients with 27 pressure sores around the pelvis.Patients were treated as Protocol performing a procedure in two surgical times, the first being the debridement and the second, the flap to fill the remaining soft tissue defect.The patients were discharge from hospital with an intravenous antibiotic treatment for an approximate period of 4-6 weeks for chronic osteomyelitis underlying clinical evolutionary controls and laboratory of erythrocyte sedimentation rate and C-reactive protein ultrasensitive. Results: 15 patients were treated, being 2 of them female. The average age was 44, 9 years (22-81).We treated 27 pressure sores, which can be divided into:-9 sacral pressure sores were treated by cutaneous flaps from the superior gluteal perforator pedicle or lumbar bipedicle perforator flap, depending on the size of the ulcers. One ulcer suffered a recurrency being treated with an advance of the same flap.-13 ischial ulcers were treated with different options, being used in 4 cases a inferior gluteus miocutaneous pedicle flap in V-Y shape. One of this suffered a new pressure sore.6 cases were treated with a muscle flap, being one of them the treatment of recurrence of a previously failed flap.Finally a patient presenting an ischial and trochanteric homolateral ulcer, was treated with a fascia lata miocutaneous flap to cover both soft tissue defects.-5 trochanteric pressure sores were treated with a fascia lata miocutaneous flap, not presenting  a recurrency.From 27 ulcers, only three of them developed a single germ, the remains ulcers developed more than one germ.The patients were treated with  intravenous antibiotic for a minimum period of 4 to 6 weeks.The initial values for the erythrocyte sedimentation rate and protein C reactive ultrasensitive were 72 mm/h and 55 mg/L respectively, after 3 months of flap surgery, values decrease 49 mm/h and 20 mg/L respectively. Discusion.Many methods have been described in the history of the management of pressure sores.The range of recurrence in the past 50 years, after a flap in this type of ulcers is between 3% and 82%.Larson et al. had a recurrence of 16.8% in 101 patients. Grassetti et al. in 143 patients with a follow-up of 2 years had a recurrence of 22.4%. Our patients were treated as Protocol in two surgical times in addition to intravenous antibiotic treatment. We treated 27 pressure sores with good results and a recurrence rate of 7.4%, comparable to the international literature. ConclusionOur Protocol reduces treatment, since it is not expected to complete the antibiotics before the flap performance. We consider that the soft tissues defects coverage as soon as possible decreases access of new microorganisms to the affected region, being an indispensable part of the effective treatment of pelvic osteomyelitis and local infection control. We obtained good results with low recurrence rate compared to other series.