Surgical Management of Osteomyelitis Fistulas: Proposed Classification and Strategic Treatment Approaches

Abstract

Mario Soares Ferreira Junior, Cristiano Ricardo Martins Teixeira, Pedro Carvalho Brandao, Isaias Chaves dos Santos, Fernando Ono, Gilberto dos Santos Nogueira and Erika Freire Cavalcante Fernandes

This article presents a comprehensive analysis of the surgical management of cutaneous fistulas secondary to chronic osteomyelitis, with emphasis on a newly proposed classification system designed to optimize treatment strategies and reduce complication rates. The classification is based on the anatomical location of the fistulas in relation to prior surgical scars, offering a pragmatic and reproducible framework that supports clinical decision-making. It facilitates the identification of cases requiring multidisciplinary collaboration, particularly those necessitating the involvement of plastic and microsurgical teams. The overarching objective is to enhance surgical outcomes by minimizing risks such as skin necrosis, wound dehiscence, and recurrent infection, especially in complex reconstructions involving compromised soft tissue. By integrating anatomical assessment with evidence-based surgical principles, the proposed approach aims to standardize care pathways, support individualized treatment planning, and improve the overall quality of care in patients with chronic osteomyelitis of the lower limb.

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