RT Journal
A1 Zalavras, Charalampos G.
A1 Femino, Dominic
A1 Triche, Rachel
A1 Zionts, Lewis
A1 Stevanovic, Milan
T1 Reconstruction of Large Skeletal Defects Due to Osteomyelitis with the Vascularized Fibular Graft in Children
JF The Journal of Bone & Joint Surgery
JO The Journal of Bone & Joint Surgery
YR 2007
FD October 1
VO 89
IS 10
SP 2233
OP 2240
DO 10.2106/JBJS.E.01319
UL http://dx.doi.org/10.2106/JBJS.E.01319
AB 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.