Bone biopsy and culture is the gold standard for diagnosis of osteomyelitis. Bone biopsy is indicated when clinical examination, laboratory findings and radiographic changes are suspicious for osteomyelitis. Chronic osteomyelitis can lead to longstanding wounds that can undergo malignant transformation into squamous cell carcinoma, and are termed Marjolin’s ulcer. Non-healing chronic wounds should also undergo a bone biopsy as well.
Bone biopsies can be obtained either from surgical debridement or percutaneously. At Foot& Ankle Doctors, Inc percutanous biopsies are performed in clinic in the following steps:
- Local anesthetic is injected in the area of skin to be biopsied
- A small incision is made over the desired area of biopsy site
- Blunt dissection is performed to the level of the bone
- A trephine biopsy needle is inserted into the area of desired bone
- Specimen sent for culture and pathology
If bone biopsy comes back positive for osteomyelitis, IV antibiotics can be started for 6 to 8 weeks. In some cases bone surgery to remove the infected bone is needed.