Osteomyelitis Presenting as a Chronic Deep Soft Tissue Ulcer
BACKGROUND: Chronic diabetic, plantar wounds are often treated with routine (often weekly) debridement, offloading, and specialty dressings. Plain radiographs may be taken as baseline during the initial evaluation and are usually not repeated. Unless bone is visible or probable, osteomyelitis usually is not suspected and therefore not included in the treatment protocol.
OBJECTIVE: This report shares the author’s experience of 8 instances of chronic plantar foot wounds that have histopathology-confirmed osteomyelitis in the ulcer bed of such wounds.
CASES & TREATMENT: Clinical suspicion of osteomyelitis was low during the initial presentation, including on plan radiographs. Visual evaluation and clinical photographs did not appear to involve bone. The wound bases were consistent with chronic wounds with granular bases and some fibrosis. The wounds were treated with standard care (weekly debridement, offloading, and appropriate dressings) for an average of 7.5 weeks (range, 4–14 weeks) before wound biopsy was performed. The biopsies were performed because the wounds were not healing in a timely manner and initially the concern was for malignancy, calciphylaxis, and/or atypical wound. Wound sizes ranged from 2.4 cm to 14.3 cm. Between 1 and 3 punch biopsies were performed into the wound bed, as indicated by wound size. Histopathology reports on these 8 wounds were all positive for chronic osteomyelitis. Standard treatment then was initiated for osteomyelitis, which included surgical debridement, intravenous antibiotics, oral antibiotics, and/or implantation of antibiotic-impregnated calcium sulfate beads along with standard wound care and offloading as indicated. To date, 7 of 8 (88%) wounds have completely resurfaced and the osteomyelitis has clinically resolved. The remaining wound continues to progress towards healing and is steadily decreasing in wound surface area.
CONCLUSIONS: Chronic wounds may have underlying osteomyelitis and clinical suspicion should be high for such wounds. A clinician cannot rely on visual observation and/or probe-to-bone tests for microscopic diagnosis.
CITATION
Gauland C. Osteomyelitis presenting as a chronic deep soft tissue ulcer. Poster presented at: Symposium on Advanced Wound Care Fall; November 2-4, 2018; Las Vegas, NV.
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This abstract was not subject to the WOUNDS peer-review process.
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