This paper provides further evidence that treatment of osteomyelitis by serial debridement without the use of local antimicrobials has high recurrence rates (20 %–30 %). The addition of bioglass did not improve this compared to using bone graft alone. Additional systemic antibiotic was required in many cases, increasing the risk of antimicrobial resistance. Recent series of single-stage surgery with local antibiotic delivery have reported better outcomes.

Osteomyelitis is commonly observed in the pediatric population across sub- Saharan Africa. This 44-patient case series presents vascularized fibula flap (VFF) as a viable option for reconstruction of post-osteomyelitis defects of pediatric long bones in low-income countries. VFF achieves good radiological and functional outcomes, although postoperative complications are common. There was no recurrence of the bone infection in any of our cases. Further prospective studies are needed.

We report the treatment of bone infection in a patient with a rare disease which causes overgrowth of the limb. Careful assessment of the scans showed that the infection was in some new bone which had formed in the soft tissues after a minor injury to the leg and not in one of the major bones. This made treatment much easier with a successful outcome.

Chronic bone infections often present with major bone and soft tissue loss which can be difficult to manage. In this study, we treated the most complex infections using surgery which reconstructed all of the tissues in one operation. We showed that this was a safe approach with very good outcomes. All of the bones healed and 96.5 % of patients were infection-free at final follow-up. This type of surgery requires close cooperation of a multidisciplinary team with expertise in major infections.