title: Lumbosacral reconstruction for intractable pyogenic spondylitis using a total leg flap with a vascularized tibia graft.
abstract: This report describes an effective technique of using a total leg flap for treating a 57-year-old male paraplegic patient with intractable sacral pyogenic spondylitis caused by methicillin-resistant Staphylococcus aureus. Spondylitis was accompanied by severe instability of the lumbosacral area, a large lumbosacral ulcer, and a large bone and muscle defect, which made it difficult for the patient to maintain a sitting position. A total leg flap procedure, a modification of the total thigh flap procedure, was performed as a 1-stage salvage surgery. The vascularized tibia and fibula were grafted between the lumbar and sacral vertebrae, and a musculocutaneous flap was used to cover the extensive ulceration in the lumbosacral skin defect. The intractable lesion of the lumbosacral spine, which had not been cured for more than 2 years despite repeated debridement, intravenous antibiotic injections, sugar treatment, pyoktanin treatment, and hyperbaric O(2) treatment, subsided and stabilized within 1 year of surgery. The patient returned to activities of daily living using a wheelchair, and was very satisfied with the results. Use of a total leg flap with a vascularized tibia graft is an effective treatment for intractable pyogenic spondylitis accompanied by a large bone defect and large lumbosacral ulcers.
authors.affiliation: Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan. kentucky@msic.med.osaka-cu.ac.jp
authors.forename: Kentaro
authors.initials: K
authors.lastname: Iwakiri
authors.forename: Akira
authors.initials: A
authors.lastname: Miyauchi
authors.forename: Shinya
authors.initials: S
authors.lastname: Okuda
authors.forename: Ken
authors.initials: K
authors.lastname: Matsuda
authors.forename: Tomio
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Motoki
authors.initials: M
authors.lastname: Iwasaki
mesh_terms: D016025:Bone Transplantation / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation; D010264:Paraplegia / Q000382:microbiology; D017060:Patient Satisfaction; D019651:Plastic Surgery Procedures / Q000379:methods*; D012447:Sacrum / Q000601:surgery*; D016038:Skin Transplantation / Q000379:methods; D012883:Skin Ulcer / Q000601:surgery; D013166:Spondylitis / Q000382:microbiology / Q000601:surgery*; D013203:Staphylococcal Infections / Q000601:surgery*; D013211:Staphylococcus aureus / Q000187:drug effects; D013524:Surgical Flaps / Q000098:blood supply; D016896:Treatment Outcome