@entity4034 in the adult @entity1 has been associated with failure of eradication, late recurrence, nonunion, and prolonged hospitalization. A staged aggressive approach has been used for the past seven years to treat 53 @entity1 with @entity4034 . This approach includes: evaluation of bone @entity39 and identification of the etiologic organisms by deep bone culture; radical surgical debridement of devascularized tissue; intensive systemic antibiotics; and early bone and soft tissue reconstruction. All @entity1 have been followed at least 1 year (mean, 33 months). Lower extremity bones predominated in the series (24 tibias, 13 femurs); and 19 @entity1 had bony instability. Thirty-seven @entity1 had initial successful eradication of their infections with 26 of these returning to full activity status. The remaining 16 @entity1 developed recurrent @entity281 ; however, 11 @entity1 totally responded to further aggressive treatment. Of the five failures in the total series, three @entity1 required amputation and two @entity1 have persistent @entity281 . Fifteen of the 19 @entity1 with bony instability healed with initial treatment, and the remaining four @entity1 healed with subsequent treatment. Six @entity1 had primary muscle flap soft tissue reconstruction, and an additional two @entity1 had reconstruction as a secondary procedure. In all these @entity1 with tibial instability, bony union was accelerated compared to those @entity1 with tibial instability not receiving muscle flaps (4 months vs 12 months). The muscle coverage provided by either pedicled flaps or transferred by microvascular anastomoses.(ABSTRACT TRUNCATED AT 250 WORDS)

An aggressive treatment approach for XXXX .

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity281 :: ('MESH:D007239', 'Disease') :: ['infection'] @entity4034 :: ('MESH:D010019', 'Disease') :: ['Osteomyelitis', 'adult osteomyelitis'] @entity39 :: ('MESH:D009336', 'Disease') :: ['necrosis']
@entity4034 :: (MESH:D010019,Disease) :: ['adult osteomyelitis']
