VASCULARIZED PARTIAL FIRST METATARSAL TRANSFER FOR THE TREATMENT OF PHALANGEAL OSTEOMYELITIS

The author reports the salvage of the index finger in a patient with e xtensive osteomyelitis of the proximal phalanx. Salvage was achieved b y a staged reconstruction, using external fixation combined with aggre ssive debridement, and an antibiotic/methyimethacrylate spacer, follow ed by a vascularized bone flap from the first metatarsal. Union was ac hieved with an excellent functional outcome of 205 degrees of total ac tive motion. The literature addressing the management of osteomyelitis in this particular location is incomplete. This author believes that loss of a large portion of the diaphysis is difficult to treat by conv entional bone grafting because of the poorly vascularized bed followin g extensive infection. The case reported is unique because of the choi ce of donor site. Vascularized bone grafting is suggested as offering the best chance for success, and the donor-site material can be easily tailored to fit the phalangeal defects.