title: Free intra-osseous muscle transfer for treatment of chronic osteomyelitis.
abstract: BACKGROUND
  Chronic osteomyelitis is still a big reconstructive challenge. Even with standard care, therapeutic failures and recurrences are common. Multiple techniques of tissue transfer have increased the success rate. This study recommends free muscle transfers into the intramedullary bone cavities for treatment of chronic osteomyelitis.
  
  
  METHODS
  The review included 29 patients that were treated for chronic osteomyelitis. Osteomyelitis was located at the femur in four patients, the tibia in 22 patients, and the foot in three patients. Dead bone and scar tissue were replaced with durable free muscle flap with special attention to fill the dead space.
  
  
  RESULTS
  The average age of these patients was 48.5 years old (range = 23-70 years old). The average duration of osteomyelitis was 8.2 years (range = 1-45 years). Gracilis was applied in 20 cases (69%), latissimus dorsi was used in five cases (17.2%), and rectus abdominis was performed in four cases (13.8%). There was one flap failure, one partial superficial flap necrosis, two arterial thrombosis, and one venous thrombosis. All the remaining 28 muscle flaps survived. From 1-10 years follow-up, there was one recurrence of the osteomyelitis in the distal end of the intra-medullary cavity of a femur after reconstructing using the gracilis flap.
  
  
  CONCLUSIONS
  The present study demonstrated that free intramedullary muscle transfers are effective in providing a high rate of success in the treatment of chronic osteomyelitis. The secondary filling of the intramedullary cavity after extensive removal of all infected bony sequesters has proven to give a long-term arrest of chronic osteomyelitis.
authors.affiliation: a 1 Department of Plastic, Reconstructive & Hand Surgery, Hue Central Hospital , Hue City, Vietnam.
authors.forename: Trung-Hau
authors.initials: TH
authors.lastname: Lê Thua
authors.affiliation: b 2 Department of Plastic Surgery, Brugmann University Hospital, Free University of Brussels, Brussels , Belgium.
authors.forename: Willy D
authors.initials: WD
authors.lastname: Boeckx
authors.affiliation: b 2 Department of Plastic Surgery, Brugmann University Hospital, Free University of Brussels, Brussels , Belgium.
authors.forename: Christophe
authors.initials: C
authors.lastname: Zirak
authors.affiliation: b 2 Department of Plastic Surgery, Brugmann University Hospital, Free University of Brussels, Brussels , Belgium.
authors.forename: Albert
authors.initials: A
authors.lastname: De Mey
keywords: Chronic osteomyelitis; debridement; free intramedullary muscle transfer