Chronic osteomyelitis following gunshot wounds.

There are three main causes, often combined, of chronic osteomyelitis due to gunshot wounds. These are retained dead matter, cavities and osteitis and are often combined. If these causes are removed the infection subsides and healing can occur. The indication for operation is clinical--persistent suppuration--and not the X-ray appearances. The nature and extent of the operation can only be determined when the sinus is explored and the cause of the suppuration ascertained. The principles of the operation are: 1) To remove the cause. 2) To provide free drainage. 3) To provide suitable mechanical condition for healing, i.e. to facilitate the obliteration of resultant spaces. When these principles can be satisfactorily applied healing occurs, but the difficulty or impossibility of applying them in some cases results in failure to cure the condition. These difficulties are anatomical. Early removal of sequestra is of great importance in reducing the severity of chronic osteomyelitis and may even prevent it.