Which is the frontline treatment for chronic osteomyelitis with a non-healing ulcer?

• A. Repeat bone aspiration & culture
• B. Admission + IV antibiotics
• C. Surgical debridement
• D. Oral antibiotics

Answer: (C)

Removing necrotic bone surgically is essential because dead bone acts as a persistent nidus for infection in chronic osteomyelitis with a non-healing ulcer. Antibiotics can’t effectively eradicate infection when there’s devitalized tissue and sequestrum, since the avascular bone limits antibiotic penetration. Debridement clears this source, allowing healing to proceed and setting the stage for targeted antibiotic therapy based on cultures. While post-debridement antibiotics (often IV first, then tailored) are important, they rely on removing the nidus first. Repeating bone aspiration or culture helps with diagnosis or monitoring but won’t cure the infection on its own, and relying solely on IV or oral antibiotics without removing necrotic bone is unlikely to resolve the condition.