Abstract
Aim
Free tissue transfer is an important tool in successful reconstruction of chronic osteomyelitis but can be challenging due to extensive scarring. Our unit follows a multidisciplinary approach including excision of osteomyelitis and immediate microvascular soft-tissue reconstruction simultaneously with orthopaedic reconstruction. We aim to evaluate the success of free tissue transfer and disease recurrence in patients with chronic osteomyelitis.
Method
This is a retrospective consecutive cohort study between 2010–2015 inclusive by a single microvascular surgeon in a single centre. All patients had one stage excision of osteomyelitis, orthopaedic reconstruction and microvascular soft tissue reconstruction, with a minimum follow-up period of 1 year.
Results
The total number of flap was 76 in 73 patients. The mean age was 45 (18–82). 63 (83%) were to cover the tibia. Flaps used were mainly gracilis (75%) and latissumus Dorsi (16%) with fibula, anteriolateral thigh, vastus lateralis and rectus abdominus also used. 40 patients had end to side anastomosis with 36 being end to end. 98% of the venous anastomosis were to the deep venae comitantes. The average flap ischaemic time was 83 minutes and the total operation time was on average 7.7 hours (5–16 hours). Total flap failure occurred in 3 patients (4%) with one additional flap having tip necrosis. All 3 patients who had total flap failure were successfully reconstructed with a 2nd free flap. 8 patients had residual infection that was successfully treated in 6 patient.
Conclusions
Chronic osteomyelitis can be treated with simultaneous excision, orthopaedic reconstruction and free soft tissue reconstruction with high level of success (>90% infection-free at one year).
Microvascular soft tissue reconstruction in these patients is almost always technically challenging and consequently a range of flaps and anastomotic techniques are required for these long operations. However, despite this, our study shows that free tissue transfer has a flap survival rate of >95%.
