Management of postinfection defects in long bones with a vascularized fibular bone graft

Abstract

Background Management of chronic osteomyelitis is a difficult task, complicated by problems including combined bone and soft-tissue loss, bacterial colonization, fibrotic local tissue, and local factors detrimental to wound healing. Vascularized bone grafts, by definition, are placed with their vascularity intact and are thus immediately viable. Objective The aim of this study was to review the clinical and radiographic results of a vascularized fibular graft (VFG) in the management of defects in upper and lower limbs with chronic osteomyelitis. Patients and methods Six patients with chronic osteomyelitis (two tibiae, two ulnae, one femur, and one radius) underwent radical debridement, followed by reconstruction using a VFG, and were evaluated for radiographic and clinical success using standard anteroposterior and lateral radiographs. Four men and two women were included and their average age at surgery was 38.8 years (range 30-50 years). Union, solid hypertrophy, range of motion, grip strength, failure of anastomosis, and recurrence of infection were evaluated at the final follow-up. Results Radiological assessment indicated union in all cases after an average period of 10.6 weeks in upper limb cases and 18 weeks in lower limb cases. Solid hypertrophy and weight bearing were allowed for lower limb cases after an average period of 12 months. No failure of the graft or recurrence of infection was encountered in this study. Conclusion VFG for the reconstruction of long bone defects following radical debridement in cases of chronic osteomyelitis effectively achieves union and eradicates infection.