Chronic Refractory Osteomyelitis

HBO is an adjunctive therapy for chronic refractory osteomyelitis that persists or recurs following treatment with primary or first line interventions. Primary/first line interventions include antibiotics, aspiration of the abscess, immobilization of the affected extremity, and surgery. The hallmarks of chronic refractory osteomyelitis include a nidus of infected dead bone or scar tissue, an ischemic soft tissue envelope, and a refractory clinical course (defined as failure after standard surgical debridement and at least six weeks of appropriate antibiotic therapy). HBO is not to be used alone but as an adjunctive therapy in combination with antibiotics. HBO can elevate the oxygen tensions found in infected bone to normal or above normal levels. This mechanism enhances healing and the body's antimicrobial defenses. It is believed that HBO augments the efficacy of certain antibiotics (gentamicin, tobramycin, and amikacin). Finally, the body's osteoclast function of removing necrotic bone is dependent on a proper oxygen tension environment; HBO provides this environment.

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