Wound excision, open cancellous grafting which eradicates infection, encourages healing of the skin by granulation and results in solid bony union.
- Swab for culture ? appropriate antibiotic pre-operatively
- Tomograms or CT to define extent of sequestrum
- Excision of infected tissue down to bleeding living tissue
- Splint the bone, if inadequate or deficient
- Defect in bone must be saucerised
- Development of granulation tissue is necessary for subsequent graft
- Secondary excision of areas not covered by granulation tissue
- Within 2/52 operate for application of cancellous graft
- Change dressings at 5/7 ? washing and daily dressing
- Continue dressings 3/52 (3 colour changes)
- By the end of the third month, entire graft incorporated into granulation tissue
- SSG applied if required
- FWB allowed at 7/12 for osteomyelitis, 9/12 where some continuity has been preserved and 12/12, if part of the shaft was completely resected