title: Using segmental renal artery as recipient artery for spinal reconstructive surgery.
abstract: METHODS
  Report of the use of one segmental artery from the left renal artery as inflow source for reconstructing a spine with recalcitrant osteomyelitis.
  
  
  OBJECTIVE
  To describe one difficult case of spinal osteomyelitis and our reconstruction procedure.
  
  
  BACKGROUND
  The use of a vascularized fibular flap for spinal osteomyelitis has been reported previously, with vascular graft having a higher successful rate of bone union and overcoming poor perfusion beds. Because repeated spinal surgery may lead to severe scarring, the choice of recipient vessels may become a difficult issue.
  
  
  METHODS
  A 49-year-old man with T12-L1 vertebral osteomyelitis experienced progressive spinal cord involvement. Because previous multiple sessions of antibiotic treatment and surgery proved unsuccessful, a 2-stage surgery was planned. Posterior lateral fusion from T9 to L3 with MOSS Miami spine system (DePuy, Spine Inc, Raynham, MA) and allogenous bone graft were performed, followed by anterior debridement and reconstruction with free vascularized fibular graft 1 week later. End-to-side vascular anastomosis was performed between the peroneal artery and the upper anterior segment artery of the left renal artery.
  
  
  RESULTS
  After more than 50 months follow-up, the patient was able to walk smoothly without the aid of a brace, walker, or crutches. There were no complications, and the radiograph showed good bony union. Furthermore, renal function was normal.
  
  
  CONCLUSIONS
  The segmental renal artery can be selected as one of the recipient vessels in spinal reconstruction surgery without detrimental effect on renal function in our case. The use of vascularized fibular flap is preferable in cases of recalcitrant spinal osteomyelitis. Staged surgery in the presence of spinal infection can offer good spinal stability and good bony union with lower infection risk.
authors.affiliation: Department of Plastic Surgery, Cathay General Hospital Hsinchu, Hsinchu, Taiwan.
authors.forename: Yu-Hsiu
authors.initials: YH
authors.lastname: Yen
authors.forename: Teh-Sheng
authors.initials: TS
authors.lastname: Hsieh
authors.forename: Shaw-Min
authors.initials: SM
authors.lastname: Hou
authors.forename: Simon Jui-Hsing
authors.initials: SJ
authors.lastname: Wu
authors.forename: Shan-Chil
authors.initials: SC
authors.lastname: Chen
authors.forename: Chi-Ming
authors.initials: CM
authors.lastname: Pu
mesh_terms: D016025:Bone Transplantation; D003646:Debridement; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012077:Renal Artery / Q000601:surgery*; D013116:Spinal Cord / Q000601:surgery*; D013123:Spinal Fusion; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome