SEMIOPEN CANCELLOUS BONE-GRAFTING - A 2-STEP METHOD FOR CLOSING SMALLINFECTED TIBIAL BONE DEFECTS

Thirteen infected small tibial bone defects with overlying skin loss w ere treated with a 2 stage procedure. In the 1st stage, antibiotic imp regnated polymethylmethacrylate bead chains were used to obliterate th e debrided osseous cavity and a meshed porcine skin graft was used for temporary wound coverage. In the 2nd stage, the bead chains were repl aced with autogenous cancellous bone graft, and the wound was again co vered with a meshed porcine skin graft. All wounds and bone grafts hea led without the need for an additional autogenous skin or bone graft. The patients were hospitalized an average of 23 days, The length of ti me to the completion of secondary epithelialization of the wound range d from 2 to 5 months (average, 3 months). The length of time to bone u nion ranged from 5 to 8 months (average, 6.4 months). An additional ap plication of porcine skin graft was required in 3 patients. Minor pin tract infections were seen in 2 patients. There was no recurrence of o steomyelitis during an average followup of 37 months (range, 24-54 mon ths). This method was helpful in securing the closure of infected tibi al bone defects with small skin losses and avoided both prolonged hosp italization and the morbidity usually accompanying free tissue transfe r or the Papineau method of open cancellous bone grafting.