Anthony and Mathes8 have provided an excellent discussion on these methods. Their review of the literature shows that prospective clinical trials have not shown the PMMA beads to be more effective than conventional therapy in the treatment of chronic osteomyelitis. They also found that the presence of these beads may inhibit the obliteration of dead space by the muscle flap. The disadvantages of implantable pumps include the ability to deliver only a limited amount of medication, the inability to modify dosage, and the necessity of a second operation for removal. Because of these drawbacks, we did not use local administration of antibiotics in this series of patients with osteomyelitis.
Simultaneous bone grafting and free flap placement offer excellent results with one less operation.
Free flaps and bone grafting currently offer the best chance for successful treatment of osteomyelitis. Because of the chronic nature of the disease, however, it would seem prudent to continue follow-up for the remainder of the patient's life to conclude the treatment was successful. I thank Diane Monsivais, MSN, and Mailly Christiansen, research assistant, for data collection and manuscript preparation. Free latissimus dorsi muscle flap with skin graft for treatment of traumatic chronic bony wounds. The efficacy of free tissue transfer in the treatment of osteomyelitis.