Muscle Free Flap Transplantation in Chronic Osteomyelitis of the Lower Extremities

PURPOSE: To evaluate the result of muscle free flap transplantation in chronic osteomyelitis of the tibia and calcaneus occurred from open fractures and exposed bones and internal fixatives. MATERIALS AND METHODS: The free muscle flap were transferred in the tibia and calcaneus and followed up average 7.3 years at the department of orthopedic surgery from March 1997 to September 2009. Six patients were male and 1 case female averaged 50.3 years of age. Two latissimus dorsi myocutaneous free flaps were transplanted to the exposed 2/3 of the tibia with soft tissue defect, one rectus abdominis muscle free flap to the mid 1/3 of the tibia and four gracilis muscle free flaps to the distal 1/3 of the tibia and calcaneus. RESULTS: At average 7.2 years follow-up, all of the 7 cases obtained solid bone union in the X-ray and kept sound soft tissues without pus discharges. The overall result of bone union, healed soft tissues defect and normal knee and ankle joint range of motion were excellent. CONCLUSION: The free muscle flap transferred to the chronic osteomyelitis of the tibia and calcaneus showed excellent results in bone union and eradication of the pus forming bacteria by its abundant blood flow.

Free Flap Coverage for Radiation Ulcer on Lumbosacral Region

Since radiation was considered as a major therapeutic modalities, chronic ulceration on lumbosacral area has been eventually generated. When the lumbosacral soft tissue defect cannot be closed with a local flap, the option of a free flap should be considered. Vascularized muscle flap is a good choice on the radiation ulcer due to chronic infection and the tissue changes of radiation effects. From October 1998 to March 2001, six patients of radiation ulcer was received microvascular transfer of five free latissimus dorsi muscle flaps and one latissimus dorsi myocutaneous flap using the superior gluteal vessel as a recipient. Patients' age ranged from 45 to 74 (mean 63.3 years of age). Mean follow-up period was 19.7months (1 to 43 months). All the flaps survived with complete recovery. One case of skin graft loss was completely healed without any further intervention. In conclusion, free muscle flap with hyperbaric oxygen therapy could be successfully applied for the treatment of radiation ulcer on lumbosacral area. It can be concluded that free muscle flap transfer with hyperbaric oxygen therapy can be a preferable therapeutic modality for radiation ulcer in lumbosacral area.

Reconstruction of Soft - Tissue Defects in the Lower Extremities Using Local or Free Muscle Flaps

According to increment of industrial accidents and traffic accidents, complex injuries of the lower extremity accompanied with broad soft-tissue defects. Lower extremity possess disadvantageous anatomical characteristics includes poor vascularity easily result in compromised circulation, rigid tissue distensibility, easy infectability followed by soft-tissue defects and relatively long healing periods. Furthermore, it easily happens that osteomyelitis or non-union was followed by bony exposure or fractures, and it must considered to weight-bearing or gate. So, It is impotant to select a appropriate method in reconstruction of the lower extremities and it is applicable to variety of surgical techniques according these considerations. The goal of flap coverage in the lower extremity should be not only satisfactory wound coverage, but also acceptable appearance and minimal donor site morbidity. The Authors estimated that skin graft and local flap surgery for bony exposed area and soft-tissue defect in weight- bearing area may not be successful. In this article, we have tried to established a reconstruction method in the lower extremity based on experiences and clinical analyses of reconstruction of the soft-tissue defects using local or free muscle flap transfer in 54 cases(49 patients) from 1993.3 to 2000.2. Results revealed 93% flap survival, but there were flap failure noted in 4 cases: one appears in the local muscle flap transfer, other three appear in the free muscle flap transfer. Among the 49 patents, 28 patients(58%) accompanied with open comminuted fractures and 11 patients (22%) visited us with infection. We think that soft-tissue defects in lower extremities associated with open comminuted fractures and infections should be reconstructed by flaps that include healthy muscles effectively due to benefits of muscle itself.