Article
Treatment of chronic osteomyelitis with vascularized fibular grafts
Search Medline for
Authors
Published: | August 16, 2017 |
---|
Outline
Text
Background: Treatment of skeletal defects secondary to osteomyelitis is a challenging and frustrating problem for the patient and surgeon. In the last 13 years 23 patients underwent vascularized fibula graft surgery for reconstruction of segmental bone defects due to debridement for osteomyelitis in upper and lower extremity at our institution.
Aim: The aim of this study was to evaluate the outcome of vascularized fibula grafts for treatment of skeletal defects due to osteomyelitis. The purpose was to assess if the vascularized fibula graft is a reliable therapeutic choice not only for last resort but as a standard method in treatment of defects secondary to osteomyelitis.
Methods: We performed retrospective analysis of the medical records of 23 patients who underwent a vascularized fibula graft procedure for treatment of osteomyelitis between 2001 and 2014. All patients who underwent this procedure for treatment of osteomyelitis with a minimum follow-up of 6 months were included in this study.
Results: The average duration taken for surgery of the 25 vascularized fibula graft procedures was 8.9 hours. Six defects involved the upper extremity, 19 the lower extremity. The overall graft survival was 84%. 7 minor (29.2%) and 4 major (12.5%) complications were diagnosed after surgery. Fibula loss occured in 4 patients and resulted in amputation. The infection recurred in 2 of 23 patients with osteomyelitis in the first two years after surgery. One patient developed osteomyelitis over 3 years after initial surgery, however there wasn’t any indication for a recurrence but for a new infection.
Conclusion: The vascularized fibula graft procedure for treatment of skeletal defects secondary to osteomyelitis seems to be a valuable reconstructive technique in this indication. The low rate of major complications, the good functional outcome and the low rate of recurrence of osteomyelitis makes the technique not only a possibility as ultima ratio treatment but can be considered as standard treatment in reconstruction of long bone defects due to osteomyelitis.