Criteria for bone debridement in massive lower limb trauma.

Adequate debridement remains the most important factor in prevention of chronic sepsis in cases of massive lower limb trauma. Despite treatment with chronic antibiotics, muscle flaps, hyperbaric oxygen, and/or free-tissue transfer, failures are common due to inadequate bone debridement. All bony fragments with marginal soft-tissue attachments and exposed bone without evidence of adequate blood flow must be removed during debridement for optimal results. Laser Doppler flowmetry (LDF) may be a useful adjunct for the assessment of bone viability during both initial and subsequent debridements. Preliminary data on eight patients have demonstrated that bone blood flow as determined by LDF is highly correlated with clinical outcome. In 13 cases, LDF has proved to be helpful in the management of chronic osteomyelitis.