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

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. J Microbiol Infect Dis 2013;3(4):