Abstract
Background: Tibial and distal femur bone deficit complicated with infection, non- union, and
soft tissue deficit was successfully repaired with ipsilateral vascular vascularized
osteo and osteocutaneous flaps.
Methods: Fractures with acute wound infection were treated with serial irrigation, debridement,
betadiene packing, or antibiotic bead chains, followed by immediate flap coverage.
Fractures with chronic infection were treated with the same protocol as acute infections,
but the infected segment was aggressively resected, 2 or 3 screws were used to stabilize
the grafted fibula to recipient sites both proximally and distally, then an external
fixator was used to protect the fixation. Atrophic non-unions were treated by resection
and primary vascularized fibular or osteocutaneous fibular flaps.
Results: Wound healing and bone union were achieved in all 4 cases. The duration of external
fixation ranged from 2 to 4 months. No postoperative infection was noticed in our
patients. In one case, a stress fracture occurred at 7 months and was successfully
managed in a PTB brace. With aggressive postoperative physical therapy, knee range
of motion was restored to an average of 95 degrees.
Conclusion: We have found that ipsilateral fibular and osteocutaneous fibular flaps are a reasonable
option for the treatment of traumatic bone deficit with or without infection, and
results in rapid and predictable recovery from atrophic non-union.
Key words
Tibia - femur - infected non-union - traumatic osteomyelitis - antibiotic beads -
tissue deficit - fibular graft - one-stage
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David Seligson M. D.
Department of Orthopedic Surgery · University of Louisville · School of Medicine
550 S. Jackson St.
ACB 3 Bridge
Louisville, KY 40202, USA
