Chronic Osteomyelitis Treatment: A Clinical and Pharmaco-Kinetic Study of Vancomycin Impregnated Calcium Sulphate

Background: Chronic osteomyelitis continues to be an intractable disease in orthopaedic surgery. Systemic antibiotics and debridement are currently the therapeutic mainstays. Calcium sulphate impregnated with antibiotics is commonly used to eradicate bone infection although there are few reports of its use. Methods: We treated 14 patients with chronic osteomyelitis using surgical debridement, a myocutaneous flap, systemic antibiotics, and vancomycin-loaded calcium sulphate, 12 males and 2 females, with an average age of 47 years (range: 17 to 65 years). In our study, 200 mg to 1000 mg of vancomycin was mixed with 5 cc of calcium sulphate and administered locally at the time of surgery. Tissue cultures were also taken at the same time. Vancomycin levels were determined in the drainage fluid after surgery. Fourteen patients with chronic osteomyelitis of the tibia, calcaneus, or ankle were treated for duration of two years and two months. The location and size of the infection was recorded. Subsequently, the patients were followed up clinically. Results: Satisfactory results were achieved in all patients. All cultures finally showed no growth, all wounds healed, and bone healing in 4 to 12 months. The lowest dose of vancomycin used was 200 mg and was associated with drain fluid concentrations of vancomycin that is much higher than the minimum inhibitory concentration (MIC) of treated bacteria. Medical imaging based on X-ray was performed pre- and post-surgery to evaluate surgical success. Conclusions: A myocutaneous flap that is combined with the 200 mg vancomycin-loaded calcium sulphate was an effective treatment for tibia and calcaneus osteomyelitis less than 4 cm in size.