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Use of Topical Negative Pressure in the Treatment of Chronic OsteomyelitisA Case Report
Wee Leon Lam, MBChB, MRCS1; Anselmo Garrido, MBBS, FRCS2; Paul R.W. Stanley, MBBS, FRCS(Plastic Surgery)2
1 1, Springfield Terrace, Leeds LS17 8NU, United Kingdom. E-mail address: weeleon@yahoo.com
2 Department of Plastic and Reconstructive Surgery, Castle Hill Hospital, Hull and East Yorkshire NHS Trust, Castle Road, Cottingham, East Yorkshire HU16 5JQ, United Kingdom
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The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Department of Plastic and Reconstructive Surgery, Castle Hill Hospital, East Yorkshire, United Kingdom

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Mar 01;87(3):622-624. doi: 10.2106/JBJS.C.01743
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The use of topical negative pressure is now an established practice among many surgeons for the treatment of difficult wounds, both as a frontline therapy and as a salvage procedure. Among difficult wounds, few present more of a challenge to the reconstructive surgeon than chronic osteomyelitis of the lower limb. Acutely, persistent sinuses and fistulas typically involve the whole length of the bone, necessitating extensive débridement that often results in extensive skin loss. Exposed bone and, frequently, exposed medullary cavities, leave a surface unsuitable for skin-grafting or conventional dressings. It is well recognized that the muscle flap is the optimal treatment following adequate débridement and antibiotic coverage. Despite an often initially excellent clinical result, some surgeons remain cautious about the long-term outcomes of treatment with either local or free flaps because of the recurrent nature of chronic osteomyelitis1,2. Treatment options for the lower limb are often further limited by the difficult anatomical constraints, making amputation always a possibility.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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