Reconstruction of Large Skeletal Defects Due to Osteomyelitis with the Vascularized Fibular Graft in Children

Zalavras, Charalampos G.; Femino, Dominic; Triche, Rachel; Zionts, Lewis; Stevanovic, Milan
October 2007
Journal of Bone & Joint Surgery, American Volume;Oct2007, Vol. 89-A Issue 10, p2233
Academic Journal
Background: Reconstruction of large skeletal defects secondary to osteomyelitis is a challenging problem. The purpose of this study was to evaluate the outcome of the use of a vascularized fibular graft to treat such defects in children. Methods: Eight patients with a mean age of seven years and a skeletal defect with a mean length of 11.8 cm (range, 6 to 17 cm) were treated with a vascularized fibular graft. A staged protocol was used for the five patients with an active infection at the time of presentation. The first procedure consisted of radical débridement, and at the second stage a free (seven patients) or pedicled (one patient) vascularized fibular graft was used. The mean follow-up time was 5.7 years. Results: Union of the graft occurred primarily in seven of the eight patients, at a mean of 3.5 months, and after iliac crest bone-grafting in the remaining patient. There was no recurrence of deep infection. Complications developed in two patients. The mean time to full weight-bearing by the seven patients with a lower-extremity reconstruction was 8.4 months, and all patients were pain-free and able to walk without supportive devices. Conclusions: A vascularized fibular graft is a viable option for the management of large skeletal defects resulting from osteomyelitis in children. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


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