J Reconstr Microsurg 1999; 15(4): 239-244
DOI: 10.1055/s-2007-1000097
ORIGINAL ARTICLE

© 1999 by Thieme Medical Publishers, Inc.

Efficacy of Microsurgical Free‐Tissue Transfer in Chronic Osteomyelitis of the Leg and Foot: Review of 22 Cases

Ramzi Musharafieh, Omar Osmani, Umaya Musharafieh, Said Saghieh, Bishara Atiyeh
  • Departments of Orthopaedic Surgery, Family Medicine and Infectious Diseases, and Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Lebanon
Further Information

Publication History

Accepted for Publication 1999

Publication Date:
08 March 2008 (online)

ABSTRACT

The efficacy of free composite tissue transfer for the treatment of chronic osteomyelitis of the leg and foot was evaluated in a retrospective study. Twenty-two patients, operated on at the American University of Beirut between January, 1992 and December, 1996, were identified. Infection involved the heel (8), ankle (1), foot (5), and tibia (8). All patients had multiple debridement and prolonged antibiotic treatment prior to presentation. The mean duration of disease was 4.8 years (range: 1 to 25 years). There were five cases of infected tibial non-union and one case of an infected tibial bone defect measuring 15 cm.

Following radical debridement, microvascular free-tissue transfer was immediately performed. One latissimus dorsi and 13 rectus abdominis muscle flaps, as well as eight radial forearm fasciocutaneous flaps were used. At a mean follow-up of 3.8 years, there was one rectus abdominis free-flap failure in a Gustilo IIIC tibial fracture, which necessitated secondary amputation; there was no evidence of recurrence of osteomyelitis in the remaining 21 patients during the study period. The patients with tibial nonunion and bone defect healed following resection and bone transport utilizing a callus distraction technique.

The results show that free-tissue transfer is a safe and viable treatment option in chronic osteomyelitis of the leg and foot. A brief discussion of the history of microvascular free-tissue transfers, as well as their value in modern reconstructive surgery, is also presented.