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Osteomyelitis of the clavicle.

Osteomyelitis of the clavicle is a rare entity and can occur as a complication of head and neck surgery. Ten consecutive cases of the clavicular osteomyelitis were reviewed at the University of California Medical Center, Los Angeles, over the past seven years. Six cases were associated with prior surgical procedures, and five cases presented as chronic wound drainage. One case was related to a pharyngocutaneous fistula following a supraglottic laryngectomy. Four patients presented with acute symptoms resulting from hematogenous spread, and two of the four patients had Staphylococcus aureus on blood cultures. Long-term intravenous antibiotic therapy (six to eight weeks) was used to successfully treat cases of hematogenously spread osteomyelitis. Wide surgical débridement was the mainstay of treatment in the chronic conditions, with antibiotic therapy having a secondary role. Myocutaneous flaps were required in two patients who had had surgery and antecedent radiotherapy. To conclude, the surgeon should be aware that osteomyelitis of the clavicle can occur as a complication of head and neck procedures. In addition, the treatment of the chronic form of clavicular osteomyelitis is surgical débridement and possible flap reconstruction.