title: Surgical treatment options for septic non-union of the tibia: two staged operation, Flow-through anastomosis of FVFG, and continuous local intraarterial infusion of heparin.
abstract: BACKGROUND
  The treatment of septic non-union of the tibia is a challenging area.　The objective of this clinical study was to improve the treatment outcomes in patients with a highly active infection by the three strategies consisting of a two-staged operation, a flow-through technique for vascular anastomosis of a free vascularized fibular graft (FVFG), and continuous local intra-arterial infusion of heparin.
  
  
  METHODS
  Five patients with septic non-union of the tibia who were treated with an FVFG (mean age: 52.8 years) were enrolled.　The mean postoperative follow-up period was 47.2 months, and the mean length of the bone defect was 111 mm.　A two-staged operation, in which polymethylmethacrylate (PMMA) beads containing antibiotics were inserted into a bone defect followed by bone reconstruction performed with an FVFG later.　Vascular anastomosis was performed with the flow-through technique in all patients.　Immediately after FVFG, heparin was continuously infused through a femoral arterial catheter for 1 week.
  
  
  RESULTS
  Bone union was confirmed an average of 18.8 weeks after-surgery in all patients without reoperation for thrombus.
  
  
  CONCLUSIONS
  Our attempt to apply the strategies appears to be a viable treatment option for septic non-union of the tibia.
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Fukushima Medical University School of Medicine.
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Kawakami
authors.forename: Soichi
authors.initials: S
authors.lastname: Ejiri
authors.forename: Michiyuki
authors.initials: M
authors.lastname: Hakozaki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hatashita
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Sasaki
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Yoko
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Shin-Ichi
authors.initials: SI
authors.lastname: Konno
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods*; D000925:Anticoagulants / Q000008:administration & dosage*; D005260:Female; D005360:Fibula / Q000637:transplantation*; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000601:surgery*; D013977:Tibia / Q000601:surgery*
chemical_list: D000925:Anticoagulants; D006493:Heparin