Delayed Tibial Osteomyelitis 37 Years After Habu Snake Envenomation: Limb Salvage With Local Antibiotic Perfusion and Areolar Tissue Grafting

Chronic osteomyelitis in elderly patients traditionally necessitates extensive surgical interventions associated with high morbidity. We report successful minimally invasive limb salvage in an 84-year-old man with chronic tibial osteomyelitis, employing continuous local antibiotic perfusion (CLAP) and perifascial areolar tissue (PAT) grafting. The patient presented with a one-year history of purulent drainage from the anterior tibial crest, occurring 37 years after a habu snake (Protobothrops flavoviridis) bite at the same site. MRI revealed characteristic bone marrow edema, and microbiological analysis identified Staphylococcus lugdunensis. Following surgical debridement, the CLAP system delivered gentamicin at 1,200 µg/mL through stainless-steel intramedullary antibiotic perfusion pins for 14 days. Reconstruction was completed using a PAT flap harvested from the external oblique fascia, followed by split-thickness skin grafting. The patient achieved complete wound healing, pain-free ambulation, and excellent functional recovery at six-month follow-up without complications. This case highlights the efficacy of modern minimally invasive techniques for managing complex bone infections in elderly patients. The combination of targeted local antibiotic delivery and low-morbidity tissue reconstruction achieved limb salvage while minimizing surgical risks, suggesting broader applicability in similarly vulnerable populations.