MANAGEMENT OF LARGE INFESTED TIBIAL DEFECTS WITH ANTIBIOTIC BEADS LOCAL THERAPY AND STAGED FIBULAR OSTEOSEPTOCUTANEOUS FREE TRANSFER

Fifteen patients with tibial fractures complicated by large infected t ibial defects were treated with a two-stage protocol, In the first sta ge, antibiotic-impregnated polymethylmethacrylate bead chains were use d to obliterate the debrided osseous defect, and a meshed porcine skin was used for temporary wound coverage, In the second stage, the head chains were removed, and the defects were reconstructed with a microva scularized fibular osteoseptocutaneous free transfer, The time between the first and second stages of treatment was 2 to 6 weeks, The bone d efects ranged from 6 to 16 cm, and the skin defect areas ranged from 1 0 to 82 cm(2), Wound healing and bony union were achieved in all 15 ca ses, An additional muscle flap or skin graft was required for only thr ee patients with a large skin defect. Minor pin tract infections were seen in two patients, Stress fractures in three cases were successfull y managed with bracing, external skeletal fixation or plating, and can cellous bone grafting, All of the most recent roentgenograms showed go od consolidation and hypertrophy of grafted fibular bones, No recurren ce of osteomyelitis was observed during an average follow-up period of 50 months (range, 36-86 months). We therefore conclude that this trea tment protocol provides rapid recovery from osteomyelitis. The fibular osteoseptocutaneous graft is a useful method for the reconstruction o f a large tibial defect, and it also offers the unique advantage of si multaneously reconstructing a moderate skin defect.