Hematogenous or traumatic osteomyelitis persists because of (1) bacterial infection, (2) sequestration, (3) cavitation or dead space, (4) inadequacy or scarring of soft tissue. Frequently, loss of soft tissue and scarring plus cavitation (noncollapsible dead space) are the most important factors in the continuance of osteomyelitis. These problems are not solved by either sequestrectomy or administration of antibiotic agents. Ideally, treatment should include extirpation of devitalized bone and dense scar tissue. Cavities must be collapsed or filled so that only healthy vascular tissue remains in the extremity. Antibiotic control of responsible organisms is advisable and usually is mandatory. Because treatment of the patient with chronic osteomyelitis must be individualized, this therapeutic ideal frequently must be compromised.
Murray RA. Importance of Soft Tissue to Treatment of Chronic Osteomyelitis. JAMA. 1962;180(3):198-203. doi:10.1001/jama.1962.03050160014004