Antibiotic therapy

The aim of appropriate treatment for chronic osteomyelitis is not only to heal the infection and prevent any possible relapse, but also to restore satisfactory vascularization and viability in the surrounding tissues and functional recovery of the limb. First surgical treatment is required to completely excise the sinus tract and remove necrotic bone tissue (both superficial and next to the medullary canal) and the infected soft tissues [1?5]. The goal of surgery is to keep only healthy and viable tissues around the primary site of infection; necrotic tissues should be excised until the bone bleeds (so-called "paprika sign") [2, 6]. When infection affects a wide area, local d?bridement creates a large bone defect, called "dead space", which, due to the poor vascularization, represents an optimal site for infection persistence and development; moreover, it compromises the stability of the entire bone segment. Therefore, appropriate medical and surgical management of the "dead space" is mandatory to stop the infection and restore the bone integrity [7].