Free vascularised fibular grafting in the treatment of large skeletal defects due to osteomyelitis

Abstract

Treatment of skeletal defects secondary to osteomyelitis is a challenging problem. The purpose of this study was to present our experience of the use of free vascularised fibular grafts to treat such defects. Ten patients with a mean age of 31 years (range 16-50 years) and a skeletal defect with a mean length of 9.5 cm (range 6-17 cm) were managed with a protocol which included radical debridement of the lesion and a vascularised fibular graft. The mean follow-up time was 26 months. Union of the graft occurred in all patients, at a mean of 4.5 months. No recurrence of osteomyelitis was observed. The mean time to full weight bearing was ten months, and all patients were pain-free and able to walk without supportive devices. A free vascularised fibular graft is a viable option for the management of large skeletal defects resulting from osteomyelitis.

Autologous bone graft in the treatment of post-traumatic bone defects: a systematic review and meta-analysis

“…Infection status of the cases was reported pre- and post-operative in 22 studies [16, 18, 19, 21, 23, 24, 26, 27, 29–33, 35, 36, 40, 41, 43–47]. The pooled estimate of mean effect size showed about 6-fold decrease of infection after treatment compared with pre-operative situation (OR = 0.17 (95 % CI 0.08 to 0.36), p  < 0.001; Q = 58.6, p  < 0.001, df = 21, I 2  = 64.2 %).…”

“…In some circumstances, additional procedures such as the change of a broken implant, compression in the nonunion site or cancellous graft in nonunion areas at bone ends, may be necessary and they raised the union rate to 98 % in published studies (Additional file 4) [15, 17–23, 25–31, 33–35, 39, 41, 42, 46–48]. …”

Vancomycin-loaded nano-hydroxyapatite pellets to treat MRSA-induced chronic osteomyelitis with bone defect in rabbits

“…Although osseous defects can be repaired using various methods such as bone grafting, bone infection and osseous defects are the two main problems associated with chronic osteomyelitis [26]. However, a substantial morbidity is associated with the harvesting of bone grafts and with bone transportation [27].…”

Vascularization in Bone Tissue Engineering Constructs

“…For example, vascularized fibular grafting (Figure 3A) takes advantage of the small vessels from harvested fibula grafts to repair bone defects by microvascular anastomosis. 111 Free vascularized flap techniques, including those from the iliac crest, scapula, and radial forearm, can help restore the vascularity of the damaged bone and its surrounding tissue. 17 However, autograft supply is limited and can cause pain, damage, or morbidity at the donor site.…”