Efficacy of microsurgical free-tissue transfer in chronic osteomyelitis ofthe leg and foot: Review of 22 cases

The efficacy of free composite tissue transfer for the treatment of chronic osteomyelitis of the leg and foot was evaluated in a retrospective study. Twenty-two patients, operated on at the American University of Beirut betwe en January, 1992 and December, 1996, were identified. Infection involved th e heel (8), ankle (1), foot (5), and tibia (8). All patients had multiple d ebridement and prolonged antibiotic treatment prior to presentation. The me an duration of disease was 4.8 years (range: 1 to 25 years). There were Rye cases of infected tibial non-union and one case of an infected tibial bone defect measuring 15 cm. Following radical debridement, microvascular free-tissue transfer was immed iately performed. One latissimus dorsi and 13 rectus abdominis muscle flaps , as well as eight radial forearm fasciocutaneous flaps were used. At a mea n follow-up of 3.8 years, there was one rectus abdominis free-flap failure in a Gustilo IIIC tibial fracture, which necessitated secondary amputation; there was no evidence of recurrence of osteomyelitis in the remaining 21 p atients during the study period. The patients with tibial nonunion and bone defect healed following resection and bone transport utilizing a callus di straction technique. The results show that free-tissue transfer is a safe and viable treatment o ption in chronic osteomyelitis of the leg and foot. A brief discussion of t he history of microvascular free-tissue transfers, as well as their value i n modern reconstructive surgery, is also presented.