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Trophic ulcers in osteomyelitis
Last reviewed: 07.07.2025
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Trophic ulcers in osteomyelitis are a variant of post-traumatic ulcers. They represent a deep defect of the skin and soft tissues, etiologically associated with a focus of purulent bone destruction. The anamnesis of such patients usually includes data on bone fractures, bone operations. In some patients, trophic ulcers in osteomyelitis occur against the background of the chronic hematogenous form of the disease.
Trophic ulcers in osteomyelitis are usually localized directly above the site of destruction, small in size, with uneven edges, with perifocal inflammation and abundant purulent discharge. The bottom is the affected bone, which is revealed during revision of the wound with a clamp. In more than 90% of cases, trophic ulcers in osteomyelitis are found in the lower third of the shin and on the foot.
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Diagnosis of trophic ulcers in osteomyelitis
The diagnosis is confirmed by an X-ray examination of the bones in two projections, which determines the signs of bone-destructive damage. Fistulography allows for a more accurate identification of the localization and extent of bone tissue damage, leaks, and the presence of sequesters. In complex diagnostic cases, CT or MRI is performed. Ultrasound helps to identify the localization and prevalence of purulent leaks and the presence of bone sequesters.
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Treatment of trophic ulcers in osteomyelitis
Trophic ulcers in osteomyelitis are treated only by surgical methods. In some cases, spontaneous healing of the defect is possible after removal of freely lying bone sequesters. In other cases, it is necessary to plan surgical intervention, the success of which entirely depends on the possibility of radical surgical treatment of the purulent bone focus. The volume of bone tissue removal is determined individually, depending on the volume of bone damage and the characteristics of the pathological process. It can consist of both simple sequestrectomy and resection of fairly large bone areas. In case of extensive purulent-necrotic damage to bones and soft tissues, especially in elderly and senile patients with signs of severe arterial insufficiency of the limb, the issue of limb amputation is decided.
Depending on the specific clinical situation, the bone cavity is drained with a silicone tube for active aspiration or myoplasty is performed. In case of segmental bone defects, compression-distraction osteosynthesis is performed in the Ilizarov apparatus, and in rarer cases, plastic surgery of the bone defect is performed with a free bone graft on microvascular anastomoses.
In addition to radical surgical treatment of the purulent bone focus, the purulent soft tissue focus is treated with careful opening and drainage of purulent leaks, excision of all non-viable tissue. It is advisable to postpone skin grafting of the ulcer or wound defect until the second stage after persistent resolution of acute inflammatory changes. Autodermoplasty, local tissue grafting, including rotational fasciocutaneous flaps, Italian skin grafting, and combined skin grafting techniques are used to close soft tissue defects. In case of extensive deep defects, free transplantation of fasciocutaneous, muscle-cutaneous, and other types of flaps on microvascular anastomoses brings good results.
Osteomyelitic ulcers of the foot are most often detected in patients with neuropathic or mixed forms of diabetic foot syndrome. The metatarsal bones and phalanges of the toes are mainly affected. In case of osteomyelitis of the metatarsal bone, surgical treatment includes exarticulation of the corresponding toe, resection of the metatarsal bone within healthy bleeding tissues, excision of the ulcer, wide opening and excision of the purulent focus in the soft tissues of the foot. In some cases, with local damage to the head of the metatarsal bone or purulent osteoarthritis, resection of the metatarsophalangeal joint with excision of the ulcerative defect of the foot and preservation of the toe is possible. Trophic ulcers in osteomyelitis of the phalanges of the toes are treated by amputation of the toe or exarticulation of the toe with resection of the head of the corresponding metatarsal bone.
Prognosis of trophic ulcers in osteomyelitis
The prospects for healing trophic ulcers in osteomyelitis and the prevention of its recurrence depend entirely on the radicality of the surgical treatment of the purulent focus of bone and soft tissue, and the adequacy of the planned bone and skin grafting.