title: Reverse sural flap with bifocal Ilizarov technique for tibial osteomyelitis with bone and soft tissue defects.
abstract: Tibial osteomyelitis, in association with bone loss and a soft tissue defect, poses a significant reconstructive challenge, especially in high-risk patients. We describe a case of methicillin-resistant Staphylococcus aureus tibial osteomyelitis with intercalary bone loss successfully managed with bifocal Ilizarov compression osteogenesis at the bone resection site and proximal distraction osteogenesis, accompanied by a reverse sural fasciocutaneous flap performed with a delayed technique. When free tissue transfer is not a reconstructive option owing to medical comorbidities or patient refusal, the reverse sural flap combined with bifocal Ilizarov compression and distraction osteogenesis can provide a reconstructive option to achieve limb salvage for these challenging cases.
authors.affiliation: Chief, Foot and Ankle and Limb Preservation Service, Department of Orthopaedics, Marshfield Clinic, Marshfield, WI; Department of Surgery, Division of Plastic and Reconstructive Surgery, Hospital of The University of Pennsylvania, Philadelphia, PA. Electronic address: christopher.bibbo@uphs.upenn.edu.
authors.forename: Christopher
authors.initials: C
authors.lastname: Bibbo
mesh_terms: D000328:Adult; D006801:Humans; D018889:Ilizarov Technique; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D010019:Osteomyelitis / Q000382:microbiology / Q000628:therapy*; D013203:Staphylococcal Infections / Q000382:microbiology; D013524:Surgical Flaps; D013977:Tibia / Q000601:surgery*
keywords: distraction osteogenesis; external fixation; flap; intercalary tibial defect; length inequity; limb salvage; tibia