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

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.

Facial Skin Tuberculosis by Mycobacterium abscessus

The incidence of the tuberculosis infection has decreased worldwide, but it is still easy to find the patients in some areas or some races. And it is very difficult to diagnose and treat the patients who are infected by the atypical tuberculosis. Facial skin infection by atypical tuberculosis has not been reported. We report the case of a 62-year-old woman who developed facial skin and soft tissue necrosis caused by Mycobacterium abscessus after receiving liquid silicone injections and face lift operation. We cultured the pathogenic organism and treated the wound with radical curettage, debridement, skin graft and tuberculosis medication.