The treatment of chronic osteomyelitis by saucerisation and secondary skin grafting.

The treatment of chronic osteomyelitis is often straightforward and effective. An episode of acute recrudescence often responds to rest and antibiotics. A discharging sinus may be caused by a sequestrum, the removal of which is followed by healing. Obliteration of cavities by bone grafting and cover by flap or pedicle graft has been advocated. Saucerisation and closure, after removal of sequestra and infected granulation tissue, is probably the procedure most commonly used, but it is not always possible to avoid pocketing because of the situation of the infection. Thus, cavities extending down into the femoral condyles or lying in the upper end of the tibia just below the knee joint are difficult to drain, and recurrence of infection is common. Occasionally amputation is unavoidable. Skin grafting the cavity after excision of infected bone is not a new procedure (Robertson 1945), and was widely practised for gunshot wounds during the second world war. Knight and Wood (1945) advocated the method as a stage in the obliteration of cavities by bone grafting but, though it has certain advantages when simpler methods have not proved effective, it has not received attention as an elective and final procedure. In the first place, it seems never to fail. A thin split-skin graft will take well over live cancellous bone and over cortical bone which has a thin covering of periosteum or granulation tissue, and in our series there was no case with less than 80 per cent take at the first dressing. In time the graft thickens and it lasts indefinitely. The first patient in the series was treated by grafting in 1945 and his leg has remained healed ever since save for occasional minor ulceration within the cavity. In no case so far has there been recurrence or spread of bone infection after the operation. In one or two cases there has been minor ulceration of the skin graft from time to time. In one instance the cavity became difficult to keep clean because insufficient soft tissue was removed from its periphery, and a second operation was carried out to widen the approach to the bone, with complete relief of symptoms. Perhaps the most satisfying feature of the operation has been the immediate and complete relief of pain.