INFECTION OF VASCULARIZED FIBULAR GRAFTS

Between June 1978 and July 1991, 64 limb reconstructions were done usi ng vascularized fibular grafts. Of these, 10 became infected. Five gra fts were proven viable, whereas the other 5 were proven nonviable base d on the survival of the skin in the composite osteocutaneous graft an d from bone scans, angiograms, and biopsies. A distinct difference in the radiologic manifestation and clinical course of the infection was noted between the viable grafts and nonviable grafts. The viable graft s showed radiologic changes of osteomyelitis that were localized, and the graft incorporated, healed with antibiotics, and exhibited graft h ypertrophy. In the nonviable grafts, the radiologic changes were exten sive, evidence that resorption of the grafts had resulted. This sugges ts that, because of the poor prognosis associated with infection of th e nonviable vascularized fibular grafts, the infected grafts should be removed early to minimize the morbidity and to shorten the protracted course associated with infection. With the infected viable grafts, ef forts at salvaging the graft with multiple debridements and systemic a ntibiotics were rewarding.