Treatment of tibial osteomyelitis by transfer of distally based sural nerve compound flaps

Abstract

Objective To explore the possibility of treating tibial osteomyelitis with transfer of a compound flap composed of the sural nerve fasciocutaneous flap and the lateral gastroenemius muscle.Methods We observed in cadaver specimens the anatomical structure of the sural nerve fasciocutaneous flap and the lateral gastrocnemius muscle to design a compound flap. Fifteen cases of tibia] osteomyelitis were treated with sinus excision and thorough debridement before the skin defect area was covered with a sural nerve compound flap whose muscle was stuffed into the tibia] channel. Plates were replaced with unilateral fixators in 3 cases of tibial nonunion. Results We observed 5 to 6 perforating branches of blood vessels between the sural nerve fascioeutaneous flap and the lateral gastroenemius muscle, indicating that the two can be harvested simultaneously in one compound flap. The transferred compound flaps survived in 15 cases. Tibial os-teomyelitis was completely cured in 14 cases, 1 case healed after second debridement, and 3 cases of tibial nonunion healed 6 months later after a second stage iliac bone graft. No recurrence was found after a mean follow-up of 18 (10 to 26) months. Conclusion A compound flap composed of the sural nerve fascio-cutaneous flap and the lateral gastrocnemius muscle can be used to treat tibia] osteomyelitis effectively. Key words: Surgical flaps; Tibia; Osteomyelitis