title: The distally based sural musculoneurocutaneous flap for treatment of distal tibial osteomyelitis.
abstract: BACKGROUND
  The treatment of distal tibial osteomyelitis represents a challenge for orthopedic and plastic surgeons. The affected tissues should be debrided and good vascularized tissue should cover the defect, but the option of a muscle flap covering the area is limited. Free flaps are used but require longer operating time and experience with microsurgery, may result in donor-site morbidity, and sometimes add bulky tissue to the area. The authors present their experience with a sural musculoneurocutaneous flap for the treatment of chronic osteomyelitis of the distal tibia.
  
  
  METHODS
  Over a 2-year period, nine distally based sural musculoneurocutaneous flaps were used in the treatment of chronic osteomyelitis of the distal tibia. Four patients had comorbid conditions (smoking, diabetes mellitus, venous insufficiency, or obesity). The clinical aspect was represented by drainage sinuses located in the distal part of the tibia. Five patients had postsurgical scars on the lateral malleolar region and one had medial and lateral malleolar scarring. Three patients had an Ilizarov device at the time of wound coverage.
  
  
  RESULTS
  All wounds were closed successfully. Dehiscence surrounding the flap was encountered in a single case that was attributable to inadequate bone debridement; this flap was raised to allow extending the debridement, and a local medial fasciocutaneous flap completed wound coverage. Distal tip necrosis of the flap was encountered in two cases.
  
  
  CONCLUSIONS
  The sural musculoneurocutaneous sural flap was successfully used for treatment of distal tibia osteomyelitis. Although it is believed that lateral malleolar scars might compromise the flap, the flaps in the authors' series survived. This flap can also be applied to patients with external fixators without removing the apparatus.
authors.affiliation: Haifa, Israel From the Departments of Plastic and Reconstructive Surgery and Orthopedic Surgery A, Rambam Medical Center, and Faculty of Medicine, Technion-Israel Institute of Technology.
authors.forename: Lucian
authors.initials: L
authors.lastname: Fodor
authors.forename: Zvi
authors.initials: Z
authors.lastname: Horesh
authors.forename: Alexander
authors.initials: A
authors.lastname: Lerner
authors.forename: Ytzhack
authors.initials: Y
authors.lastname: Ramon
authors.forename: Isaac J
authors.initials: IJ
authors.lastname: Peled
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Ullmann
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000601:surgery*; D019651:Plastic Surgery Procedures; D013524:Surgical Flaps / Q000098:blood supply*; D013977:Tibia