One-stage surgical treatment for thumb osteomyelitis accompanied with soft tissue defects: free flap transplantation from fibular side of the big toe

Abstract

Objective To investigate the indications and efficacy of one-stage surgical treatment for phalanx osteomyelitis of the thumb by debridement and soft tissue defect coverage with fibular flap from the big toe. Methods From May 2013 to May 2015, 11 cases of phalanx osteomyelitis of the thumb with soft tissue defect were treated. After thorough debridement, the bone defect was filled with a non-vascularized bone graft while a flap from the fibular side of the big toe was transferred to cover the soft tissue defect all in the same stage. Postoperative evaluations included cure of osteomyelitis, motor function of the thumb, and the sensation, color and texture of the flap. Results All the patients were follow-up for 4 to 12 months, with an average of 8 months. The osteomyelitis was effectively cured, with no recurrence. Range of motion of the thumb returned to normal. The flaps survived completely, with satisfactory sensation, appearance and texture. Conclusion One-stage thorough debridement, artificial bone grafting with sensitive antibiotics and transfer of fibular flap from the big toe can shorten the treatment time for phalanx osteomyelitis of the thumb with soft tissue defects. The cost is lower while the outcomes are good. Key words: Osteomyelitis; Finger injuries; Surgical flaps; Soft tissue defect