Treatment of chronic osteomyelitis using the medial sural perforator flap

The successful treatment of chronic osteomyelitis requires radical debridement followed by the obliteration of anatomical defects. It presents one of the most difficult challenges in medicine. The reconstruction of these defects with local or free non-muscle flaps also enables good blood flow as per that observed in muscle flaps. This is known as an alternative approach for treating chronic osteomyelitis.

Between April 2003 and February 2008, the authors operated on 18 patients suffering from chronic osteomyelitis over a 6-week period. The coverage of anatomical dead spaces with medial sural perforator free flaps was performed after debridement, primarily on those areas that required thin vascularised flaps such as the pretibia, the ankle, the dorsum of the hand and the scalp.

Fourteen of 18 clinical cases with anatomical defects after radical debridement were successfully treated with the use of a medial sural perforator free flap. Partial or total necrosis of the flap was identified in four cases. In all of these four cases, with a single exception, the causes were identified as uncontrolled diabetes and underlying vascular insufficiency. They were successfully resurfaced with a local flap, skin graft for coverage of small skin defects without a recurrence of chronic osteomyelitis.

The medial sural perforator free flap is superior to other muscular free flaps in the reconstruction of thin areas, because it is adequately vascularised and does not require debulking procedures. It is anticipated that the medial sural perforator free flap will be more actively applied in the treatment of chronic osteomyelitis.