Chronic osteomyelitis management in austere environments: the International Committee of the Red Cross experience.
BACKGROUND
Chronic osteomyelitis (COM) causes major physical disability. In situations of limited resources and war zones, western world treatments are neither affordable nor sustainable. The International Committee of the Red Cross has established a COM treatment project in the Democratic Republic of Congo, with emphasis on affordability and sustainability.


METHODS
One hundred and sixty-eight patients were treated for COM. The protocol focused on surgical excision of necrotic bone, physiotherapy and an open wound dressing method using granulated brown sugar.


RESULTS
Seventy-one patients could be reviewed with a mean follow-up of 13.7 months (5-28 months). 46 patients (63.4%, 95% CI 52.5-75.6) had excellent/good results in terms of clinical cure of the infection, and 36 patients (50.7%, 95% CI 38.7-62.7) had seen excellent/good improvement in their functional status compared with before treatment.


CONCLUSIONS
The above-mentioned treatment protocol has shown encouraging results: almost two-thirds of the patients had their infection clinically cured, and half the patients saw significant functional improvement.
International Committee of the Red Cross, Geneva, Switzerland.
Marco
M
Baldan
Richard A
RA
Gosselin
Zaher
Z
Osman
Kenneth G
KG
Barrand
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D002985:Clinical Protocols; D003646:Debridement; D015023:Democratic Republic of the Congo; D019422:Dietary Sucrose / Q000627:therapeutic use; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000628:therapy*; D010020:Osteonecrosis / Q000601:surgery; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D026741:Physical Therapy Modalities; D012011:Red Cross; D014857:Warfare; D058106:Wound Closure Techniques; D055815:Young Adult
D000900:Anti-Bacterial Agents; D019422:Dietary Sucrose
Osteomielitis crónica; ambientes austeros; austere environments; blessure de guerre; chronic osteomyelitis; emplasto de azúcar; environnements austères; heridas de guerra; ostéomyélite chronique; pansement à base de sucre; sugar dressing; war injury