A wound that has failed to heal, after adequate use of antibiotics as well as surgical measures, often lends itself to the need for osteomyelitis treatment options. Osteomyelitis comes in many forms and can be acute, subacute, or even chronic. This disease is seen as a bacterial infection within the bone. When left untreated it can spread quite rapidly and requires immediate attention. Even with aggressive treatment, the recurrence rate of chronic osteomyelitis is quite high and prolonged treatment is almost always a necessity.
Common osteomyelitis treatment options include the use of multiple antibiotics and surgeries to remove the infection. These options often have little to no effect on existing bone infections. For many patients, antibiotics and surgery are simply not enough. Chronic refractory osteomyelitis becomes an issue as bone infections fail to heal and become increasingly more severe. However, choosing the best treatment for these bacterial bone infections can be quite a challenge. Often, a combination of a variety of methods proves to be the most effective in treating refractory osteomyelitis. Since there are so many factors involved when it comes to treating osteomyelitis, deciding on the best treatment option is done meticulously on a case by case basis. Alternative and effective osteomyelitis treatment options are available and being aware of them is the first step in removing this disease.
Hyperbaric oxygen therapy has been used as an alternative refractory osteomyelitis treatment since 1965. Hyperbaric chambers offer 100 percent oxygen in order to destroy bacteria in bone infections. It also helps to transport antibiotics through bacterial cell walls, making the combined use of HBO therapy and traditional antibiotics insurmountably effective.
Multiple studies have been conducted to monitor and evaluate the effectiveness of this therapy and the reported success rates have been outstandingly high. Nearly 80 percent of all included refractory osteomyelitis patients experienced little to no recurrence of infection after the completion of a series of hyperbaric oxygen therapy treatments. Complete wound healing also occurred as a direct result of this alternative treatment option. One study found that 34 out of 38 patients that had been treated with hyperbaric oxygen therapy, in conjunction with standard antibiotics and debridement, were completely symptom free in as little as 34 months.
Managing chronic osteomyelitis involves a difficult process, but with the right treatment options and the use of alternative methods, it can be effectively managed and completely eliminated.
Hyperbaric Medical Center of Michigan has shown excellent results in the treatment of refractory osteomyelitis.
Wound Healing Perspectives: A Clinical Pathway to Success Volume 8 No. 2 2011
A 2008 report by Hart, published by the Undersea and Hyperbaric Medical Society, concluded that the addition of hyperbaric oxygen therapy to routine surgical and antibiotic management in previously refractory osteomyelitis is safe and improves the ultimate rate of infection resolution. The report further states that in most cases, when treating refractory osteomyelitis, the best clinical results are obtained when HBO is used in conjunction with culture-directed antibiotics and when it is initiated soon after thorough surgical debridement. Based on the report’s findings, Hart suggests, hyperbaric oxygen therapy should be considered an American Heart Association Class II recommendation in the management of refractory osteomyelitis.
“In vitro and in vivo studies have subsequently uncovered specific mechanisms of action. Common to each of these mechanisms is the restoration of normal to elevated oxygen tensions in the infected bone. Mader and Niinikoski demonstrated that the decreased oxygen tensions typically associated with bony infections can be returned to normal or above normal levels while breathing 100% oxygen in a hyperbaric chamber. Achieving such elevations has important consequences for the hypoxic milieu of osteomyelitic tissues.”
Hyperbaric Oxygen Therapy in the Treatment of Chronic Refractory Osteomyelitis: A Preliminary Report
Chin-En Chen, MD; Shu-Tai Shih, MD; Te-Hu Fu1, MD; Jun-Wen Wang, MD; Ching-Jen Wang, MD
Background: Hyperbaric oxygen (HBO) has been proven to enhance bone and soft tissue healing in ischemic tissue in vitro and in vivo studies. Although only a few reports have been proven using controlled studies, this treatment modality remains encouraging for chronic refractory osteomyelitis. In this retrospec- tive study, we reported the clinical results of HBO therapy for chronic refrac- tory osteomyelitis.
Methods: From January through August 2000, 14 patients with chronic refractory osteomyelitis of the tibias treated with HBO were available for follow-up examination. According to the Cierny-Mader classification, all patients were classified as type III or IV osteomyelitis. Adequate debridement and par- enteral antibiotic treatment in conjunction with HBO therapy at 2.5 atmos- pheres absolute for 120 minutes, and 5 days per week regimen was used in all patients. The patients were followed-up for an average of 15 months after completion of HBO therapy.
Results: The most common infecting microorganism was Staphylococcus aureus. Mixed infections were usually found in patients with open fractures. The average number of operations before HBO therapy was 5.4 including soft tis- sue reconstruction in 11 patients. The average number of HBO treatments was 33.6 times. There were no HBO related complications. No recurrence of infection was noted in 11 patients, which resulted in a success rate of 79%.
Conclusions: Hyperbaric oxygen therapy is effective and safe for chronic refractory osteomyelitis provided that patients had received appropriate medical and surgical management. (Chang Gung Med J 2003;26:114-21)
American College of Hyperbaric Medicine Chronic Refractory Osteomyelitis Pathophysiology and Hyperbaric Effects
The results of several open clinical trials indicate that adjunctive hyperbaric oxygen therapy is useful in the treatment of chronic osteomyelitis. Slack reported on five patients with refractory chronic osteomyelitis who showed clinical improvement after treatment with hyperbaric oxygen at two absolute atmospheres. Perrins reported on 24 patients with chronic, recurrent osteomyelitis and cutaneous sinus tracts, in whom previous sequestrectomy, antibiotics, or marsupialization had been unsuccessful. A combination of HBOT and antibiotic therapy resulted in healing of 17 of Perrins’ 24 cases. In four of the non-healed cases, drainage from the sinus tract diminished. In the remaining three cases, the sinus tracts were not influenced by the treatment.