title: VAC Therapy Direct to the Medullary Cavity for Chronic Tibial Osteomyelitis.
abstract: BACKGROUND
  Vacuum-assisted wound closure (VAC) is useful for difficult wound beds, although sites where bleeding or infection is expected are usually regarded as problematic for this therapy. This report outlines the treatment of chronic tibial osteomyelitis (Cierny- Mader type III) due to mixed infection with Nocardia spp and Bacteroi- des fragilis by postoperative VAC therapy direct to the medullary cavity, followed by wound coverage with a gastrocnemius myocutaneous skin flap.
  
  
  METHODS
  A 64-year-old man developed chronic left tibial os- teomyelitis after a work injury. The nonviable tissues were debrided, including a sequestrum. Nocardia spp and B. fragilis were isolated from surgical bone specimens, and chronic tibial osteomyelitis due to mixed infection was diagnosed. Postoperatively, VAC therapy was performed directly to the open medullary cavity of the tibia and sub- sequently covered the residual soft tissue defect with a gastrocnemius myocutaneous flap.
  
  
  CONCLUSIONS
  The authors could not find any English literature on VAC therapy direct to the medullary cavity combined with transplantation of a myocutaneous flap for osteomyelitis. Nocardia spp can cause a variety of infections, among which osteomyelitis occupies a relatively small percentage.
  
  
  CONCLUSIONS
  This case raises the possibil- ity of treating chronic tibial osteomyelitis caused by mixed infection with Nocardia spp and B. fragilis by applying postoperative VAC ther- apy directly to the medullary cavity and covering the residual wound with a gastrocnemius myocutaneous flap.
authors.affiliation: Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Osaka, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Miyamura
authors.affiliation: Department of Orthopaedic Surgery, National Hospital Organization, Osaka Minami Medical Center, Osaka, Japan.
authors.forename: Shigeyoshi
authors.initials: S
authors.lastname: Tsuji
authors.affiliation: Department of Orthopaedic Surgery, Iwai Hospital, Fukui, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Iwai
authors.affiliation: Department of Orthopaedic Surgery, Japan Community Health Care Organization, Hoshigaoka Medical Center, Osaka, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hamada
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods*; D006801:Humans; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D010019:Osteomyelitis / Q000628:therapy*; D019651:Plastic Surgery Procedures / Q000379:methods*; D017695:Soft Tissue Injuries / Q000473:pathology / Q000628:therapy*; D013978:Tibial Fractures / Q000473:pathology*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents