title: Recalcitrant post-traumatic chronic osteomyelitis/infected non-union of the tibia following open grade-ill fractures: treatment with vascularized osteocutaneous fibular graft.
abstract: Post-traumatic chronic osteomyelitis and infected non-unions of the tibia following severe type-III open fracture are difficult to treat Refractoy cases often necessitate amputation despite attempts to salvage the limb. We report our experience in treating such difficult cases with an alternative surgical option using free osteocutaneous fibular graft. Eight consecutive patients with post-traumatic chronic osteomyelitis/infected non-union were treated surgically with free vascularized osteocutaneous fibular graft. Outcomes in term of graft-host union and complication were evaluated. Four patients had anastomotic venous thrombosis requiring anastomotic revision. Five patients developed surgical site infections needing extended antibiotic therapy to achieve resolution at an average of 15.2 weeks. Fibular graft fracture occurred in three patients but all grafts survived and united after a mean time to union of 42.3 weeks (range 31 to 82 weeks). At the final follow-up, union of host-graft junction and control of infection were achieved in all patients except one who required a secondary amputation. Free vascularized osteo-cutaneous fibular graft is a viable limb salvage option for refractory chronic osteomyelitis or infected non-union following treatment of grade-III open tibial fractures.
authors.affiliation: Reconstructive Science Unit, Department of Surgery, Universiti Sains Malaysia, Kubang Kerian.
authors.forename: A S
authors.initials: AS
authors.lastname: Halim
authors.forename: Y
authors.initials: Y
authors.lastname: Imran
mesh_terms: D000328:Adult; D002908:Chronic Disease; D017759:Fractures, Malunited / Q000150:complications* / Q000382:microbiology; D005597:Fractures, Open / Q000150:complications* / Q000382:microbiology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000209:etiology* / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology* / Q000601:surgery; D013978:Tibial Fractures / Q000150:complications / Q000382:microbiology / Q000601:surgery*; D013997:Time Factors; D019737:Transplants; D017211:Treatment Failure