Chronic osteomyelitis of skull associated with necrotic injury after trauma: A case report

Öz

Otuziki yaşında erkek hasta acil servise sağ temporoparietal alanda 4x11 cm doku defekti ile getirildi. Beyin tomografisinde sağ parietal alanda doku defekti görüldü fakat kemik doku bütünlüğü korunmaktaydı. Kraniyal kemiklerin korunması amacıyla serbest flep operasyonu yapıldı. Hastaneden taburcu olduktan 2 ay sonra nekrotik görünümde kirli akıntılı yara ile başvurdu. Tomografide temporoparietal alanda kemik defekti görüldü. Ampirik antibiyotik tedavisi başlandı. İlk aşamada nekrotik dokular debride edilerek granülasyon dokusu oluşumu için hasta izlendi. Doku ve kemik kültüründe Pseudomonas aeruginosa üremesi saptandı. Patoloji sonuçları kronik osteomiyelit ile uyumlu geldi. Granülasyon dokusu gelişiminden sonra skalpten rotasyon flebi yapıldı. Hastanın antibiyotik tedavisi 6 haftaya tamamlandı. Altı hafta sonrasında 3 boyutlu tomografi görüntülemelerinde osteoblastik aktivite ve kemik oluşumu görüldü

Anahtar Kelimeler

• Antibiyotik tedavisi, kronik osteomyelit, enfeksiyon

Chronic osteomyelitis of skull associated with necrotic injury after trauma: A case report

Abstract

A 32-year-old male came to the emergency room with a crescentric 4x11 cm tissue defect at the right temporo-parietal region. Brain tomography showed a tissue defect in the right parietal region but bone integrity was preserved. A free flap procedure was performed to protect the cranial bones. Two months after discharge from the hospital, he presented with a draining dirty wound that appeared necrotic. Computed tomography showed a bone defect in the temporoparietal area. Empiric antibiotic treatment was initiated. The necrotic tissues were debrided as a first step and the patient was followed for granulation tissue development. Pseudomonas aeruginosa was identified from soft tissue and bone samples. Pathology results were consistent with chronic osteomyelitis. A rotation flap from the scalp was prepared after granulation tissue development. The patient\'s antibiotic treatment was completed in 6 weeks. After 6 weeks, three dimensional computed tomography showed osteoblastic activity and bone formation.

Keywords

• antibiotic treatment, chronic osteomyelitis, infection

Kaynakça

1. Lew DP, Waldvogel FA. Osteomyelitis. Lancet 2004364:369- 379.
2. Prasad KC, Prasad SC, Mouli N, Agarwal S. Osteomyelitis in the head and neck. Acta Otolaryngol 2007;127:194-205.
3. Valerón-Almazán P, Gómez-Duaso AJ, Rivero P, et al. Exten- sive, non-healing scalp ulcer associated with trauma-induced chronic osteomyelitis. Ann Dermatol 2011;23:364-367.
4. Malone DG, O’Boynick PL, Ziegler DK, et al. Osteomyelitis of the skull base. Neurosurgery 1992;30:426-431.
5. Lew DP, Waldvogel FA. Osteomyelitis. N Engl J Med 1997;336:999-1007.
6. Berbari EF, Steckelberg JM, Osmon DR. Osteomyelitis. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases,. 7th edn. Philadelphia: Churchill Livingstone, 2010:1457-1467.
7. Pincus DJ, Armstrong MB, Thaller SR. Osteomyelitis of the craniofacial skeleton. Semin Plast Surg 2009;23:73-79.
8. Santiago Restrepo C, Gimenez CR, McCarthy K. Imaging of osteomyelitis and musculoskeletal soft tissue infections: cur- rent concepts. Rheum Dis Clin North Am 2003;29:89-109.

9. Kaim AH, Gross T, von Schulthess GK. Imaging of chronic posttraumatic osteomyelitis. Eur Radiol 2002;12:1193-1202.
10. Abdul-Karim FW, McGinnis MG, Kraay M, et al. Frozen sec- tion biopsy assessment for the presence of polymorpho- nuclear leukocytes in patients undergoing revision of arthro- plasties. Mod Pathol 1998;11:427-431.
11. Conterno LO, da Silva Filho CR. Antibiotics for treating chronic osteomyelitis in adults. Cochrane Database Syst Rev 2009;3:CD004439.
12. Howard CB, Einhorn M, Dagan R, et al. Fine-needle bone biopsy to diagnose osteomyelitis. J Bone Joint Surg Br 1994;76:311-314.
13. Jacobson IV, Sieling WL. Microbiology of secondary osteo- myelitis. Value of bone biopsy. S Afr Med J 1987;72:476-477.
14. Eckardt JJ, Wirganowicz PZ, Mar T. An aggressive surgical approach to the management of chronic osteomyelitis. Clin Orthop Relat Res 1994;298:229-239.
15. Simpson AH, Deakin M, Latham JM. Chronic osteomyelitis. The effect of the extent of surgical resection on infection-free survival. J Bone Joint Surg Br 2001;83:403-407.