200 Section - Treatment of osteomyelitis in lower extremity using free vascularized bone graft

Osteomyelitis in the lower extremities is often accompanied by open fractures, and the surrounding soft tissue is frequently defective and difficult to treat, leading to amputation. We report the results of osteomyelitis treatment by free vascularized bone and tissue transfer for limb salvage.


Design:

Ten patients were eligible for this study. Eight of them had sustained osteomyelitis of tibia and others were femur and calcaneus. All had several surgeries previously. After debridement of the infected bone, all were treated with free vascularized bone transfer. Multiplanar external fixators were applied for tibial cases.


Results:

All flaps survived. Nine of them were cured and achieved bone union without infection. One case without negative pressure wound therapy sustained infection again due to insufficient debridement and antibiotic-resistant bacteria.


Conclusions:

Microsurgical technique has enabled simultaneous reconstruction of bone tissue, defective skin and subcutaneous tissue by means of free vascularized bone and soft tissue transfer. Nevertheless, appropriate debridement of infected tissues and treatment with effective antibiotics remains crucial to control infection. After control of the infection and transplantation of vascularized bone, rigid bone fixation is necessary for bone union. Multiplanar external fixators with ring components are useful tools for promoting stability and adjusting bone alignment. They also effective for elevating surgical sites, decreasing swelling and preventing the compression of anastomosed vessels.

Although treatment of osteomyelitis is challenging, it can be cured by staged operation.