Long-term follow-up of chronic osteomyelitis after bone tumor resection.

Abstract

The standard treatment for chronic osteomyelitis after trauma is affected bone resection and bone and soft tissue defect reconstruction. However, few reports exist regarding chronic osteomyelitis after bone tumor surgery. We retrospectively reviewed five cases of chronic infection after bone tumor surgery, including their treatment strategy and clinical course. We reviewed three cases of giant cell tumors of bone and two cases of osteosarcoma. Reconstruction was performed after tumor resection in all cases. Despite careful management, fistula formation and chronic infection occurred. Two patients underwent radical surgery for chronic infection. After the infection subsided, reconstruction was performed again. However, in one case, the infection recurred, and consequently, amputation was performed. When radical surgery is performed, implant replacement is essential due to biofilm formation. Controlling soft tissue infection, besides bone and implant infection, is important. In some cases, however, radical surgery is undesirable, and patients choose to live with the chronic infection instead. Even when methicillin-resistant S. aureus (MRSA) was detected, anti-MRSA drugs were used only in the early stages, after which the infection was managed by switching to oral antibiotics, such as minocycline and sulfamethoxazole-trimethoprim combination drugs. Careful follow-up is necessary due to the risk of fistula cancer in conservative management.