Two-stage reconstruction with free vascularized soft tissue transfer and conventional bone graft for infected nonunions of the tibia: 6 patients followed for 1.5 to 5 years.
BACKGROUND
Vascularized soft tissue transfer may give better results of treatment of infected nonunions of the tibia.


METHODS
6 patients with infected nonunion of the tibia and combined soft tissue (70-170 cm(2)) and bony (5-8 cm) defects underwent staged reconstruction. Initial surgery consisted of soft tissue and bone debridement, external fixation, filling of the bony defect with a gentamicin-impregnated cement spacer, and reconstruction of the soft tissue with a free microsurgical muscle flap and skin graft. Second-stage surgery consisted of removal of the cement spacer and osseous reconstruction with nonvascularized bone graft.


RESULTS
All patients except 1 achieved full weight-bearing and radiographic consolidation after 7-10 months. This patient required repeated bone grafting and internal plate fixation to heal. There were no cases of recurrence of infection at the latest follow-up, after a mean of 3 (1.5-5) years.


CONCLUSIONS
Staged reconstruction with free vascularized soft tissue transfer and conventional bone grafting within a cement-induced membrane is a low-risk surgical strategy resulting in a high rate of bone healing.
Department of Orthopaedics, University of Zurich, Switzerland.
Philip B
PB
Schöttle
Clément M L
CM
Werner
Charles E
CE
Dumont
D000328:Adult; D016025:Bone Transplantation; D003646:Debridement; D005260:Female; D005360:Fibula / Q000293:injuries; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D017102:Fracture Healing; D005597:Fractures, Open / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D017695:Soft Tissue Injuries / Q000382:microbiology / Q000601:surgery; D013524:Surgical Flaps; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D016896:Treatment Outcome