Reconstruction of large skeletal defects due to osteomyelitis with the vascularized fibular graft in children.
BACKGROUND
Reconstruction of large skeletal defects secondary to osteomyelitis is a challenging problem. The purpose of this study was to evaluate the outcome of the use of a vascularized fibular graft to treat such defects in children.


METHODS
Eight patients with a mean age of seven years and a skeletal defect with a mean length of 11.8 cm (range, 6 to 17 cm) were treated with a vascularized fibular graft. A staged protocol was used for the five patients with an active infection at the time of presentation. The first procedure consisted of radical débridement, and at the second stage a free (seven patients) or pedicled (one patient) vascularized fibular graft was used. The mean follow-up time was 5.7 years.


RESULTS
Union of the graft occurred primarily in seven of the eight patients, at a mean of 3.5 months, and after iliac crest bone-grafting in the remaining patient. There was no recurrence of deep infection. Complications developed in two patients. The mean time to full weight-bearing by the seven patients with a lower-extremity reconstruction was 8.4 months, and all patients were pain-free and able to walk without supportive devices.


CONCLUSIONS
A vascularized fibular graft is a viable option for the management of large skeletal defects resulting from osteomyelitis in children.
Zalavras
Charalampos G
CG
Department of Orthopaedic Surgery, Keck School of Medicine at the University of Southern California, Los Angeles County, CA, USA. zalavras@usc.edu
Femino
Dominic
D
Triche
Rachel
R
Zionts
Lewis
L
Stevanovic
Milan
M
D000293:Adolescent; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005360:Fibula / Q000098:blood supply / Q000637:transplantation*; D006801:Humans; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D010012:Osteogenesis; D010019:Osteomyelitis / Q000601:surgery*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016896:Treatment Outcome