Long-term results of multiple-stage treatment for posttraumatic osteomyelitis of the tibia.
BACKGROUND
The treatment of posttraumatic osteomyelitis of the tibia requires meticulous debridement and adequate soft tissue coverage. At our institution, we perform a staged procedure consisting of surgical debridement followed by muscle coverage. If necessary, implantation of a cancellous iliac bone graft was always performed as a three-stage treatment.


METHODS
We performed a retrospective analysis of 47 patients treated for posttraumatic osteomyelitis of the tibia between 1987 and 1998.


RESULTS
Twenty-two patients originally had a Gustilo grade III fracture, 21 patients had a Gustilo grade I or II or closed fracture, the Gustilo grade was not known for 2 patients, and 2 patients had no fracture. Using the Cierny-Mader classification, most patients had a localized osteomyelitis. To cover the debrided area, 20 pedicled muscle transfers and 28 microvascular free flaps were used; one patient had two localizations of osteomyelitis (both proximal and distal) and received two muscle flaps. Flap failure was 8% and was successfully treated by additional flap coverage in two cases; one was closed by a split skin graft and one was closed by secundum. Twenty-six patients received a cancellous bone graft. During an average follow-up of 94 months, 9% had a recurrence of osteomyelitis for which additional surgical interventions were necessary. Finally, all the infections were eventually cured.


CONCLUSIONS
Our staged surgery proved to be an excellent method of treating osteomyelitis after open or closed fractures of the tibia.
Tulner
Sven A F
SA
Department of Plastic and Reconstructive Surgery, University Hospital, Academic Medical Center, Amsterdam, The Netherlands. s.a.f.tulner@lumc.nl
Schaap
G R
GR
Strackee
S D
SD
Besselaar
P P
PP
Luitse
J S K
JS
Marti
R K
RK
D000293:Adolescent; D000328:Adult; D000368:Aged; D016025:Bone Transplantation; D003646:Debridement; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery; D011552:Pseudomonas Infections / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D016038:Skin Transplantation; D013203:Staphylococcal Infections / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D013524:Surgical Flaps; D013977:Tibia / Q000000981:diagnostic imaging / Q000601:surgery*; D013978:Tibial Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*