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J Reconstr Microsurg 2004; 20(1): 13-20
DOI: 10.1055/s-2004-818044
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA

Vascularized Fibular Grafting in the Treatment of Methicillin-Resistant Staphylococcus Aureus Osteomyelitis and Infected Nonunion

Hiroshi Yajima1 , Yasunori Kobata1 , Koji Shigematsu1 , Kenji Kawamura1 , Kenji Kawate1 , Susumu Tamai1 , Yoshinori Takakura1
  • 1Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
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Publication History

accepted: September 11, 2003

Publication Date:
18 February 2004 (online)

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Twenty patients with methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis and bone infection were treated with vascularized fibular grafts. There were 16 males and four females, and the patient ages at operation ranged from 17 to 73 years. Nine of the lesions affected the femur, eight the tibia, and there were three others. All of the patients were treated with extensive debridement of the lesions and local antibiotic therapy. Continuous local irrigation was applied in two patients, antibiotic-formulated bone cement in five, and both in 10 patients. Recurrence of local infection occurred in six patients, including one failed graft. Eventually, 18 of the 20 cases attained successful subsidence of the inflammation. The mean period required to obtain radiographic bone union was 7 months in the femoral reconstruction group, 6.1 months in the tibial reconstruction group, and 6 months in the remaining patients. The authors believe that vascularized fibular grafting is the most reliable procedure for the treatment of MRSA osteomyelitis and infected nonunion.

KEYWORDS

Methicillin-resistant osteomyelitis - infected bone non-union - vascularized fibular grafting

REFERENCES

  • 1 Taylor G I, Miller G DH, Ham F J. The free vascularized bone graft: a clinical extension of microvascular techniques.  Plast Reconstr Surg. 1975;  55 533-544
    Search in Google Scholar
  • 2 Yajima H, Tamai S, Mizumoto S, Ono H. Vascularized fibular grafts for reconstruction of the femur.  J Bone Joint Surg. 1993;  75B 123-128
    PubMedSearch in Google Scholar
  • 3 Weiland A J, Moore J R, Daniel R K. The efficacy of free tissue transfer in the treatment of osteomyelitis.  J Bone Joint Surg. 1984;  66A 181-193
    PubMedSearch in Google Scholar
  • 4 Yajima H, Tamai S, Mizumoto S, Inada Y. Vascularized fibular grafts in the treatment of osteomyelitis and infected nonunion.  Clin Orthop. 1993;  293 256-264
    PubMedSearch in Google Scholar
  • 5 Yajima H, Tamai S, Ono H, Kizaki K. Vascularized bone grafts to the upper extremities.  Plast Reconstr Surg. 1997;  101 727-735
    PubMedSearch in Google Scholar
  • 6 Yajima H, Tamai S. Twin-barrelled vascularized fibular grafting to the pelvis and lower extremity.  Clin Orthop. 1994;  303 178-184
    Search in Google Scholar
  • 7 Barber M. Methicillin-resistant Staphylococci.  J Clin Pathol. 1961;  14 385-393
    CrossrefPubMedSearch in Google Scholar
  • 8 Sheftel T G, Nader J T, Pennick J J, Cierny III G. Methicillin-resistant staphylococcus aureus osteomyelitis.  Clin Orthop. 1985;  198 231-239
    PubMedSearch in Google Scholar
  • 9 Matsushita K. Osteomyelitis of the long bone [in Japanese].  Orthop Surg Traumatol. 1998;  41 1027-1036
    PubMedSearch in Google Scholar
  • 10 Schentag J J, Hyate J M, Carr J R, et al.. Genesis of methicillin-resistant Staphylococcus aureus (MRSA), how treatment of MRSA infections has selected for vancomycin-resistant Enterococcus faecium, and the importance of antibiotic management and infection control.  Clin Infect Dis. 1998;  26 1204-1214
    PubMedSearch in Google Scholar
  • 11 Hill D A, Herford T, Parratt D. Antibiotic usage and methicillin-resistant Staphylococcus aureus: an analysis of causality.  J Antimicrob Chemother. 1998;  42 676-677
    CrossrefPubMedSearch in Google Scholar
  • 12 Sorrell T C, Packham D R, Shanker S, et al.. Vancomycin therapy for methicillin-resistant Staphylococcus aureus.  Ann Intern Med. 1982;  97 344-350
    PubMedSearch in Google Scholar
  • 13 Compere E L. Treatment of osteomyelitis and infected wounds by closed irrigation with a detergent antibiotic solution.  Acta Orthop Scand. 1962;  32 324-33
    PubMedSearch in Google Scholar
  • 14 Vecsei V, Barquet A. Treatment of chronic osteomyelitis by necrectomy and gentamicin-PMMA beads.  Clin Orthop. 1981;  159 201-207
    PubMedSearch in Google Scholar
  • 15 Ozaki T, Yoshitaka T, Knisada T, et al.. Vancomycin-impregnated polymethylmethacrylate beads for methicillin- resistant Staphylococcus aureus (MRSA) infection: report of two cases.  J Orthop Sci. 1998;  3 163-168
    CrossrefPubMedSearch in Google Scholar
  • 16 Enneking W F, Eady J L, Burcharbt H. Autogenous cortical bone grafts in the reconstruction of segmental deficits.  J Bone Joint Surg. 1980;  62A 1039-1057
    PubMedSearch in Google Scholar
  • 17 Fitzgerald Jr R H, Ruttle P E, Arnold P G, et al.. Local muscle flaps in the treatment of chronic osteomyelitis.  J Bone Joint Surg. 1985;  67A 175-185
    PubMedSearch in Google Scholar
  • 18 Yajima H, Tamai S, Yamaguchi T. Muscle flap transfer in the treatment of chronic osteomyelitis [in Japanese].  Seikeigeka. 1988;  39 1597-1604
    PubMedSearch in Google Scholar
  • 19 Minami A, Kaneda K, Itoga H. Treatment of infected segmental defect of long bone with vascularized bone transfer.  J Reconstr Microsug. 1992;  8 75-82
    Thieme ConnectPubMedSearch in Google Scholar
  • 20 Doi K, Kawakami F, Hiura Y, et al.. One-stage treatment of infected bone defects of the tibia with skin loss by free vascularized osteocutaneous grafts.  Microsurgery. 1995;  16 704-712
    CrossrefPubMedSearch in Google Scholar

Hiroshi YajimaM.D. 

Department of Orthopaedic Surgery, Nara Medical University

840 Shijyo-cho, Kashihara

Nara 634-8522, Japan