Onur URAL, Ender KÖKTEKİR, Şua SÜMER, Mehtap KARAMEŞE

Travma sonrası kafa kemiğinde nekrotik yara ilişkili kronik osteomyelit: Olgu sunumu

Otuziki yaşında erkek hasta acil servise sağ temporoparietal alanda 4x11 cm doku defekti ile getirildi. Beyin tomografisinde sağ parietal alanda doku defekti görüldü fakat kemik doku bütünlüğü korunmaktaydı. Kraniyal kemiklerin korunması amacıyla serbest flep operasyonu yapıldı. Hastaneden taburcu olduktan 2 ay sonra nekrotik görünümde kirli akıntılı yara ile başvurdu. Tomografide temporoparietal alanda kemik defekti görüldü. Ampirik antibiyotik tedavisi başlandı. İlk aşamada nekrotik dokular debride edilerek granülasyon dokusu oluşumu için hasta izlendi. Doku ve kemik kültüründe Pseudomonas aeruginosa üremesi saptandı. Patoloji sonuçları kronik osteomiyelit ile uyumlu geldi. Granülasyon dokusu gelişiminden sonra skalpten rotasyon flebi yapıldı. Hastanın antibiyotik tedavisi 6 haftaya tamamlandı. Altı hafta sonrasında 3 boyutlu tomografi görüntülemelerinde osteoblastik aktivite ve kemik oluşumu görüldü.

Chronic osteomyelitis of skull associated with necrotic injury after trauma: A case report

A 32-year-old male came to the emergency room with a crescentric 4x11 cm tissue defect at the right temporo-parietal region. Brain tomography showed a tissue defect in the right parietal region but bone integrity was preserved. A free flap procedure was performed to protect the cranial bones. Two months after discharge from the hospital, he presented with a draining dirty wound that appeared necrotic. Computed tomography showed a bone defect in the temporoparietal area. Empiric antibiotic treatment was initiated. The necrotic tissues were debrided as a first step and the patient was followed for granulation tissue development. Pseudomonas aeruginosa was identified from soft tissue and bone samples. Pathology results were consistent with chronic osteomyelitis. A rotation flap from the scalp was prepared after granulation tissue development. The patient's antibiotic treatment was completed in 6 weeks. After 6 weeks, three dimensional computed tomography showed osteoblastic activity and bone formation. J Microbiol Infect Dis 2013;3(4)

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