Reconstructive Strategies in Post-Traumatic Osteomyelitis of the Lower Limb: A Case Series and Surgical Algorithm...

Area of Science:

• Orthoplastic Surgery
• Reconstructive Surgery
• Trauma Surgery

Background:

• Post-traumatic osteomyelitis (PTO) of the lower extremity presents significant challenges in orthoplastic reconstructive surgery.
• Management necessitates integrated infection control, skeletal fixation, and vascularized soft-tissue coverage.

Purpose of the Study:

• To evaluate the outcomes of reconstructive strategies for lower extremity PTO.
• To assess flap survival, complication rates, infection resolution, and limb salvage in patients treated at a tertiary orthoplastic center.

Main Methods:

• Retrospective case series of 20 patients with lower limb PTO treated between 2021 and 2024.
• Included radical debridement, culture-directed antibiotics, and reconstruction with local muscle, fasciocutaneous, or free flaps; vascularized bone flaps for select nonunion cases.
• Primary outcomes: flap survival, complications, infection resolution, limb salvage.

Main Results:

• Overall flap survival was 90% with various flap types utilized (sural, hemisoleus, gastrocnemius, peroneus brevis, free flaps).
• Infection resolved in 90% of patients; one patient underwent amputation due to nonunion.
• At a mean 10-month follow-up, all limb-salvaged patients were ambulatory.

Conclusions:

• A patient-specific algorithm considering defect characteristics and comorbidities optimizes PTO reconstruction.
• Local flaps are reliable for most defects; free or vascularized bone flaps are reserved for complex cases.
• Early referral, radical debridement, and orthoplastic collaboration are crucial for limb salvage success.