Ｖｅｎｏａｄｉｐｏｆａｓｃｉａｌ ｆｌａｐと抗生物質入りビーズを用いて治療した下腿骨骨髄炎の２例

Abstract

We successfully treated two tibial osteomyelitis combined with a skin defect. We used antibiotic-impregnated cement beads in both patients together with a venoadipofascial (VAF) flap or a venoneuroadipofascial (V-NAF) flap. The VAF flap and the V-NAF flap, described by Nakajima, are fasciocutaneus flaps supplied by accompanying arteries of the cutaneous veins and cutaneous nerves. Both patients were male whose age at surgery were 45 years and 17 years. The skin defects after radical debridement of osteomyelitis were covered with a VAF flap (5cm×4cm) and a V-NAF flap (7cm×5cm). Skin grafs were required to cover the donor sites. At 4 months and 2 months after the flaps, cancellous bone grafs were performed. Follow-up periods were 2 years and 2 months, and 2 years and 4 months. Both flaps survived completely and there has been no recurrence of osteomyelitis. We consider the VAF flap and the V-NAF flap as the treatment of choice to cover skin defects at the proximal 2/3 of the anterior aspect of the tibia. The advantages of these flaps are reliable and easy to harvest without sacrificing the major arteries.