Treatment of Chronic Osteomyelitis of Femur and Reconstruction with Fibular Osteocutaneous Free Flap.

Baik, Eui Hwan; Ahn, Hee Chang; Choi, Seung Suk; Jo, Dong In; Hwang, Kun Sung; Chung, Ung Seu

Original Article

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2006;33(5):637-642.
Published online September 1, 2006.

Treatment of Chronic Osteomyelitis of Femur and Reconstruction with Fibular Osteocutaneous Free Flap.

Eui Hwan Baik, Hee Chang Ahn, Seung Suk Choi, Dong In Jo, Kun Sung Hwang, Ung Seu Chung

¹Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, Korea. ahnhc@hanyang.ac.kr
²Department of Orthopedic Surgery, College of Medicine, Hanyang University, Seoul, Korea.

Abstract

PURPOSE
Incidence of chronic osteomyelitis in femur is lower than that of tibia due to abundantsurrounding soft tissue like muscles and subcutaneous fat. However, if the femur is infected, surgical approach would be very difficult because of surrounding soft tissue and bony defects would be getting larger due to the late detection. Chronic osteomyelitis of femur is an intractable disease with frequent recurrence and remained bone instability in spite of multiple classical operations . METHODS: From August 1998 to October 2005, we had 7 cases of fibular osteocutaneous free flap to reconstruct the femur. Those were followed-up for 23 months. All 7 cases were male. 4 cases were in midshaft and the others are distal part of femur.
RESULTS
The 7 cases that had not been healed in spite of average 9.1 times previous operations were reconstructed successfully without the recurrence of chronic osteomyelitis. Continuous rehabilitation therapy and brace were very helpful for the ambulation. It took 5.6 months for complete union of bone, and 9.8 months for the ambulation.
CONCLUSION
After wide resection, reconstruction of the femur using fibular osteocutaneous free flap guaranteed bone stability and prevented recurrence of osteomyelitis through rich blood supplying fibula and muscle. Double barrel graft of fibula would be needed in case of the sufficient strength and thickness of femur. We report the successful results of reconstruction of femur with fibular osteocutaneous free flap for chronic osteomyelitis of femur.

Keywords: Chronic osteomyelitis of femur; Reconstruction of femur; Fibular free flap