Effective management of osteomyelitis after grade III open fractures.

We report results and follow-up on a series of 34 patients who had chronic osteomyelitis resulting from complex open fractures. Treatment included debridement followed by cancellous bone grafting and simultaneous free flap transfer for coverage and revascularization. Thirty-one patients remained in the final study. For the 24 patients with lower extremity injuries, follow-up averaged 45.4 months (range, 10 to 84 months). There was a 4% recurrence rate of osteomyelitis (1 of 24 patients). Follow-up on the 7 patients with upper extremity injuries averaged 39.8 months (range, 22 to 60 months). There were no recurrences in this group. Serial debridement followed by simultaneous bone grafting and free flap transfer may be the most effective method available for the treatment of chronic osteomyelitis after grade III open fractures. This method produces the same results currently reported in the literature, but with one less operation.