Vascularized Muscular and Musculocutaneous Flaps and Vascularized Bone Segment Transfer for Management of Chronic Osteomyelitis

Chronic osteomyelitis, although treated medically and surgically, often recurs within less than 2 years because of numerous sequelae including poor blood supply, residual dead space and resistant micro-organisms. Recovery from this disease essentially involves the following treatment approaches: 1) long-term administration of various antibiotics; and 2) effective surgery. Antibiotic treatment will not prove successful until dead, osseous, and soft fibrotic tissue excision is complete. Meanwhile, wide debridement of the wound and fibrotic tissue excision makes direct closure of tissue unfeasible. Currently, rotational and free flap procedures make direct closure of wounds possible after complete debridement and removal of soft fibrotic tissue.

Clinical experience in the last 10 years indicates the success of these techniques in treatment of upper and lower limb osteomyelitis following, mitigation of sequelae along with antibiotic therapy. The remarkable effectiveness of vascularized flaps accounts for increased blood supply, more oxygen, and defense mechanisms in the infected area. To manage upper limb osteomyelitis, rotational musculocutaneous flaps followed by vascularized free fibula have been relatively successful. However, for the lower limb, musclular or musculucutaneous free flaps have been more effective. The various management and treatment protocols in chronic osteomyelitis by rotational, island, and free flap procedures were presented.