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
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.