Figure 5.

Post-traumatic left tibial chronic osteomyelitis in a French patient in failure of phage treatment administered in Georgia. A ready-made cocktail was administered locally and per os for several weeks. Bone exposure persisted (a) with large skin adherences (b) to underlying sclerotic bone (c) X-ray without any abscess or intramedullary cavity on CT-scan (d); transverse view of both legs; on the left the leg without infection, on the right the infected leg, with sclerotic bone and densification of the medulla). Heavy high-tech surgery in a CRIOAc reference center is preferably indicated, with bone curettage (only means of eradicating infected necrotic bone), resection of the large skin area around the exposed bone, related to chronic inflammation and unable to recover, with free-flap cover followed by prolonged antimicrobial therapy. Intraoperative and postoperative phage administration is clearly not feasible in such a patient.