Treatment of Calcaneal Osteomyelitis with Free Serratus Anterior Muscle Flap Transfer

Abstract

Chronic calcaneal osteomyelitis is a difficult problem to eradicate. The infected bone and soft tissue can rarely be successfully treated conservatively. But after aggressive debridement, there is usually a large defect in the calcaneus and soft tissue. Free serratus anterior muscle flap can not only fill the defect but can help eliminate the infection of the bone and soft tissue. Thirteen patients with calcaneal osteomyelitis were treated with free serratus anterior muscle flap transfer and skin graft from 2000 to 2006. The mean patient age was 36 (range, 18 to 48) years. Four patients were women and nine were men. The followup averaged 34 months (range, 6 months to 6 years). All flaps survived and there was no infection recurrence. The mean operation time was 6.3 +/- 1.3 hours. Partial skin graft necrosis was found in one patient, which resolved uneventfully after another skin graft. There was minimal donor site morbidity. Winged scapula or dysfunction of the shoulder was not found in any of the patients. The serratus anterior muscle has many advantages owing to its anatomical features. We believe it is a good option for treatment of calcaneal osteomyelitis.