Update on chronic osteomyelitis.

Recent advances in the understanding of the pathophysiology and treatment of osteomyelitis have been discussed. Some of the advances (in either knowledge or technology) that we have found particularly useful include the following: The discovery of additional prognostic factors, which allow more reliable preoperative assessment. The development of the Ilizarov device, which allows bone fixation and later limb lengthening. Confirmation of the effectiveness of single-staged debridement and muscle flap closure. Confirmation that a brief (10 to 14 day) course of antibiotics is as effective as more prolonged therapy. The development of several new free muscle donor sites and a greater appreciation of the need for careful insetting of the muscle. The development of local antibiotic delivery systems, especially continuous antibiotic irrigation catheters. The development of newer oral and intravenous antibiotics that allow outpatient therapy following surgery. The recognition that patients require extended follow-up, and that any recurrences can be successfully treated with a second debridement and muscle flap closure.