The use of anterolateral thigh perforator flaps in chronic osteomyelitis of the lower extremity.
From April of 2000 to May of 2003, 28 consecutive patients with chronic osteomyelitis of the lower extremity underwent surgical debridement and reconstruction with anterolateral thigh perforator flaps (six cases were combined with vastus lateralis muscle flaps). All wounds were open for a minimum period of 6 weeks (average, 24.7 months; range, 6 weeks to 52 months). The average patient age was 42.8 years (range, 18 to 71 years), there were 21 male and seven female patients, and the average follow-up period was 18.2 months (range, 5 to 41 months). The cause of injury was an open fracture in 10 cases, secondary wound complications after reduction in eight cases, and diabetic foot in 10 cases. The surface defects ranged from 50 to 153 cm. The wounds were debrided an average of 2.5 times and then reconstructed with flap and treated with antibiotics for 6 weeks. Antibiotic beads were used in six cases and secondary bone graft procedures were performed in seven cases 3 months after the flap coverage. All 28 flaps were successful without any signs of recurrences or persistent osteomyelitis, but partial wound dehiscence was observed during early rehabilitation in two cases suspected of delayed healing caused by diabetes. These wounds healed spontaneously. All patients achieved acceptable gait function after rehabilitation. No debulking procedure was necessary in any case. Although the muscle flap is known to provide superior vascular supply, the type of flap used for coverage seems to be less critical in the final outcome, provided that total debridement and obliteration of dead spaces are achieved. A well-vascularized anterolateral thigh perforator flap was successfully used to combat infection and bring stability to wounds with chronic osteomyelitis.
Hong
Joon Pio
JP
Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea. joonphong@amc.seoul.kr
Shin
Hyun Woo
HW
Kim
Jung Jae
JJ
Wei
Fu-Chan
FC
Chung
Yoon Kyu
YK
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003646:Debridement; D017719:Diabetic Foot / Q000150:complications / Q000382:microbiology; D005260:Female; D005360:Fibula / Q000293:injuries; D005597:Fractures, Open / Q000150:complications; D006801:Humans; D007866:Leg / Q000601:surgery*; D007869:Leg Injuries / Q000150:complications; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D010019:Osteomyelitis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D018461:Soft Tissue Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000601:surgery; D013524:Surgical Flaps / Q000098:blood supply / Q000294:innervation; D013529:Surgical Wound Dehiscence; D013978:Tibial Fractures / Q000150:complications; D014640:Vancomycin / Q000627:therapeutic use; D014945:Wound Healing
D000900:Anti-Bacterial Agents; D014640:Vancomycin