Author/Authors :
Buono, Pablo Department of Plastic, Reconstructive and Aesthetic Surgery - Geneva University Hospitals - Faculty of Medicine - University of Geneva, Switzerland , Castus, Pascal Department of Plastic, Reconstructive and Aesthetic Surgery - Geneva University Hospitals - Faculty of Medicine - University of Geneva, Switzerland , Dubois-Ferrière, Victor Orthopaedic Surgery Department - Geneva University Hospitals - Faculty of Medicine - University of Geneva, Switzerland , Rüegg, Eva Meia Department of Plastic, Reconstructive and Aesthetic Surgery - Geneva University Hospitals - Faculty of Medicine - University of Geneva, Switzerland , Uçkay, Ilker Orthopaedic Surgery Department - Geneva University Hospitals - Faculty of Medicine - University of Geneva, Switzerland , Assal, Mathieu Orthopaedic Surgery Department - Geneva University Hospitals - Faculty of Medicine - University of Geneva, Switzerland , Pittet-Cuénod, Brigitte Department of Plastic, Reconstructive and Aesthetic Surgery - Geneva University Hospitals - Faculty of Medicine - University of Geneva, Switzerland , Modarressi, Ali Department of Plastic, Reconstructive and Aesthetic Surgery - Geneva University Hospitals - Faculty of Medicine - University of Geneva, Switzerland
Abstract :
BACKGROUND Eradication of chronic tibial osteomyelitis necessitates aggressive debridement is often followed by soft tissue reconstruction. Muscular flaps are said to be more effective than non-muscular flaps for infection treatment, while fasciocutaneous and perforator flaps are considered to be less invasive and offering a better aesthetic result. METHODS In this study, we reviewed 24 consecutive cases of chronic tibial osteomyelitis treated according to a specific protocol in a tertiary hospital. Soft tissue coverage was done with either muscular or non-muscular free flaps. Infection recurrence and complications were compared between different flap types. Additionally, we assessed the long-term functional and aesthetic results and patient’s satisfaction. RESULTS Muscular flap was used in 13 patients (13 latissimus dorsi and 1 serratus anterior) and 11 patients underwent fasciocutaneous/ perforator flaps [1 anterolateral thigh flap, 4 lateral arm flaps, 5 thoracodorsal artery perforator (TAP) flaps and 1 radial forearm flap]. Infection was resolved for 84.6% of patients in the muscular flaps group and 90.9% in the non-muscular flaps group. None of the patients with muscular flaps were satisfied with the aesthetic appearance of their reconstructed leg when compared to 83.3% of patients with non-muscular flaps. Also, a slight regain of touch sensitivity was acknowledged in the non-muscular flap group compared to the muscular. CONCLUSION In this study of adult chronic tibial osteomyelitis cases, we demonstrated that fasciocutaneous and perforator free flaps offer a comparable efficacy to the muscle flaps for infection treatment, with a significantly higher patient satisfaction and aesthetic result.
Keywords :
Lower limb , Chronic osteomyelitis , Free flap , Reconstructive surgery , Microsurgery
