Outcomes Following Vascularised Bone Graft for the Treatment of Upper Limb Osteomyelitis: A Systematic Review and...

Osteomyelitis is a debilitating condition with treatment options ranging from antibiotics to surgical management. In cases where debridement of necrotic or infected tissue results in extensive bone and soft-tissue loss, creating a poorly vascularised cavity prone to persistent infection and mechanical instability, vascularised bone grafts (VBGs) can provide definitive reconstruction. This systematic review and meta-analysis aimed to assess outcomes of VBGs for upper limb osteomyelitis. A systematic search of electronic databases identified 330 papers related to VBGs, of which 10 retrospective case series met the inclusion criteria, cumulatively including 70 patients. Statistical analysis was performed using Open MetaAnalyst software (Center for Evidence-Based Medicine, Brown University, Providence, RI, US) with a random-effects model and 95% confidence intervals. The mean time to bony union post-VBG was 6.2 months, with 59 (87.7%) patients achieving union. Secondary surgery was required for 19 (26.1%) patients, and postoperative infection recurrence occurred in three (5.1%). Postoperative stress fracture was reported in one case with an overall incidence of 5.5%. These findings indicate that VBGs are an effective treatment for upper limb osteomyelitis, yielding high rates of bony union and a low incidence of complications. Compared with other treatment modalities, patients undergoing VBGs may benefit from shorter antibiotic courses and improved outcomes. Whilst the included studies were limited to retrospective series, this pooled analysis provides evidence supporting the use of VBGs as a reliable surgical option for complex upper limb osteomyelitis.