Is Surgery Necessary in Bone and Soft Tissue Infections?
Bone and soft tissue infections are among the most challenging and serious conditions in orthopedic practice. Bone infections, known as osteomyelitis, and soft tissue infections require diverse treatment approaches based on factors such as the infection’s spread, type, the structure of the infected tissue, and the patient’s immune status. The decision to perform surgery is made by evaluating these factors.
These infections typically develop when bacterial agents reach the bone and surrounding soft tissues via the bloodstream, direct extension, or traumatic injury. Acute infections are often treated effectively by surgical intervention combined with appropriate antibiotic regimens. However, in chronic infections, especially when necrotic bone tissue (sequestra) is present, the need for surgery increases significantly.
Surgical treatment becomes mandatory in cases requiring drainage of infected tissue, removal of necrotic tissue, extraction of infected implants, and debridement to halt the infection’s spread. In resistant or recurrent infections, surgery is the most effective method because antibiotics may not sufficiently penetrate the affected tissues.
In soft tissue infections, the clinical scenario varies more broadly. When there is abscess formation, necrosis, or pus accumulation in the intercellular connective tissue, surgical drainage and necrosectomy are necessary. In particular, diabetic foot infections, deep soft tissue infections, and necrotizing fasciitis require timely surgical intervention to be life-saving.
Balancing the need for surgery with antibiotic therapy depends on the patient’s overall health, the extent of infection, and the physiological characteristics of the affected area. For example, in acute hematogenous osteomyelitis, early appropriate antibiotic treatment may often suffice. In contrast, chronic bone infections typically require prolonged antibiotic therapy combined with surgery. Additionally, infections that mimic bone tumors require precise diagnosis and surgical strategy.
The Ilizarov technique, widely used in bone lengthening and deformity surgeries, also proves effective in infected cases. This method provides stability in infected regions, controls infection, and supports functional recovery. However, it is not suitable for every patient, highlighting the importance of multidisciplinary assessment.
Ultimately, the necessity of surgery in bone and soft tissue infections must be evaluated on a case-by-case basis. Early diagnosis, proper antibiotic selection, and timely surgical intervention are fundamental for controlling the infection and facilitating the patient’s recovery. Orthopedic surgeons apply surgical strategies at specific infection stages to prevent permanent damage and improve quality of life.