A staged Papineau protocol for chronic osteomyelitis.

A three-stage Papineau protocol for the management of chronic pyogenic osteomyelitis was critically investigated in 13 prospectively treated patients with draining osteomyelitis. Stage I involved removal of nonviable tissue and retained metal. Stage II involved grafting of cancellous iliac bone. In Stage III skin coverage was accomplished. Infection was eradicated in all but one patient, and the osseous defect filled in all patients. Five patients attained skin coverage after split-thickness grafting. In seven patients epithelialization occurred, while one patient underwent a soleus muscle transposition with skin grafting. The prospective protocol could have been improved by prolonged hospitalization with repeated surgical debridements. Rather than demonstrating absolute cure of all kinds of osteomyelitis, the present results reveal factors that help to ensure successful treatment.