Does Osteomyelitis Always Require Surgery? Protection Status
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by Aletha Tippett MD

Typical treatment when osteomyelitis (bone infection) is discovered is to plan a surgical treatment, usually wide debridement, but up to and including amputation. I was recently treating an 80-year-old with a wound on her foot that was healing very well. But she went to a hospital for a UTI and they found osteomyelitis under that foot wound. After much discussion they convinced her amputation was the only way, so her leg was amputated and she is now in a nursing home.

I ask the question: if the patient's wound was healing well, what problem was the osteomyelitis?

Treatment Interventions for Osteomyelitis

It turns out, according to more current thought, that most osteomyelitis can be treated with antibiotics. Over 70% of osteomyelitis cases will resolve with appropriate antibiotic treatment, or can be converted into chronic osteomyelitis. A patient can live with chronic osteomyelitis, especially a patient receiving palliative wound care.

Other treatment interventions include the use of biotherapy for debridement of the infected site. Dr. Baer, the renowned surgeon and father of modern maggot therapy, used maggots for osteomyelitis with good success. I also have used maggots for osteomyelitis with good success. My experience treating multiple cases of osteomyelitis with antibiotics yielded good outcomes, not requiring any surgeries or amputations.

Identifying the Presence of Osteomyelitis

Do you know when osteomyelitis is present? Some symptoms of osteomyelitis include bone pain, redness and pain at the site of infection, and lower extremity swelling. Other signs of infection may also be present including fever, chills and excessive sweating.

One of the best ways determine if a patient has osteomyelitis is to probe the wound with a metal probe to see if the bone is pierced. MRIs are typically ordered, but these are not always the best diagnostic. A simple x-ray can often tell if there is osteomyelitis. We have also been able to detect osteomyelitis using an infrared camera.

I would urge everyone to be aware that osteomyelitis can be present where a wound is near bone. It can readily be diagnosed with simple techniques. Then, treatment with antibiotics is preferred as the first course of action. Maggots are a viable option for treatment, as well. Your patients will thank you if they can save their legs and stay functional.

So, no, osteomyelitis does not always need surgery, in fact, osteomyelitis should rarely need a knife if appropriate treatment interventions are implemented.

About The Author
Aletha Tippett MD is a family medicine and wound care expert, founder and president of the Hope of Healing Foundation®, family physician, and international speaker on wound care.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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Thank you for bringing up this very important development. Indeed, excellent research studies on Diabetic Foot Ulcer patients show that 5 weeks of oral antibiotics (usually two are given at the same time to prevent resistance) usually clears up osteomyelitis without the need for surgical intervention. I have included the references to this and other recent studies in my latest Clinical Education brochure: Prevention and Management of Arterial and Diabetic Foot Ulcers. It is being laid out now and should be available as a free download at soon.

Thank you Dr. Tippett for the other side! Our treatment of osteomyelitis in the wound care world is as variable as everything else that we do. Once again, we need to treat the patient with the disease, not just the disease. As those specialists in the non-wound care world make aggressive decisions about our patients who desire a palliative approach to care, we need to be patient advocates. Surgery is an option but not for the 80 year old with multiple medical problems who would not the survive the transition of care needed for recovery from such a surgery. Patient's have choices!

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