Medical expert of the article
New publications
Trophic ulcers with osteomyelitis
Last reviewed: 23.04.2024
All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Trophic ulcers in osteomyelitis - a variant of posttraumatic ulcers. They represent a deep defect in the skin and soft tissues, etiologically associated with a focus of purulent bone destruction. In the anamnesis, such patients usually have data on bone fractures, operations on the bones. In a number of 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 source of destruction, small in size, the edges are uneven, with perifocal inflammation and abundant purulent discharge. The bottom is the affected bone, which is revealed when the wound is examined with a clamp. More than 90% of cases of trophic ulcers in osteomyelitis are found in the lower third of the shin and on the foot.
What's bothering you?
Diagnosis of trophic ulcers in osteomyelitis
Confirms the diagnosis of radiographic examination of bones in two projections, in which the signs of bone-destructive lesion are determined. Fistulography can more accurately detect the localization and volume of damage to bone tissue, feces, the presence of sequestration. In complex diagnostic cases, CT or MRI is performed. Helps to identify the localization and prevalence of purulent feces and the presence of bone sequesters of ultrasound.
[How to examine?
Who to contact?
Treatment of trophic ulcers in osteomyelitis
Trophic ulcers are treated with osteomyelitis only by surgical methods. In some cases, spontaneous healing of the defect is possible after removal of free-lying bone sequesters. In other cases, it is necessary to plan surgical intervention, the success of which depends entirely on the possibility of carrying out a radical surgical treatment of the purulent focus of the bone. The volume of bone tissue removal is determined individually, depending on the extent of bone damage and the features of the course of the pathological process. It can consist of both simple sequestrectomy and resection of large areas of bone. With extensive purulent-necrotic lesion of bones and soft tissues, especially in elderly and senile patients with signs of severe arterial insufficiency of the limb, the question of limb amputation is being decided.
Depending on the specific clinical situation, the bone cavity is drained with a silicone tube for active aspiration or myoplasty is performed. With segmental bone defects, compression-distraction osteosynthesis is performed in the Ilizarov apparatus, in rare cases - bone defect repair by a free bone graft on microvascular anastomoses.
In addition to radical surgical treatment of the purulent foci, the bones are treated with a purulent foci of soft tissues with careful opening and drainage of purulent fouling, excision of all non-viable tissues. Cutaneous plasty of a ulcerative or wound defect is desirable to be postponed to the second stage after a stable resolution of acute inflammatory changes. To close soft-tissue defects, autodermoplasty is used, plastic with local tissues, including plastic rotary cutaneous-fascial flaps, Italian skin plasty, combined methods of skin plasty. With extensive deep defects, a free transplantation of cutaneous-fascial, cutaneous and muscular and other types of flaps on the microvascular anastomoses brings good results.
Osteomyelitis ulcers of the foot are most often detected in patients with a neuropathic or mixed form of diabetic foot syndrome. Damaged mainly metatarsal bones and bones of phalanges of toes. In osteomyelitis of the metatarsal bone, surgical treatment includes the exarticulation of the corresponding finger, resection of the metatarsal bone within the healthy bleeding tissues, excision of the ulcer, wide opening and excision of the purulent focus in the soft tissues of the foot. In a number of cases, with local involvement of the metatarsal head or purulent osteoarthritis, resection of the metatarsal-phalanal joint with excision of the ulcerative foot defect and preservation of the toe is possible. Trophic ulcers in osteomyelitis of the phalanges of the toes are treated by amputation of the finger or finger exarticulation with a resection of the head of the corresponding metatarsal bone.
Prognosis of trophic ulcers in osteomyelitis
The prospect of healing trophic ulcers in osteomyelitis and the prevention of its relapse entirely depend on the radical nature of the surgical treatment of the purulent focus of bone and soft tissues, the adequacy of the planned bone and skin plasty.