Infection of vascularized fibular grafts

Between June 1978 and July 1991, 64 limb reconstructions were done using vascularized fibular grafts. Of these, 10 became infected. Five grafts were proven viable, whereas the other 5 were proven nonviable based on the survival of the skin in the composite osteocutaneous graft and from bone scans, angiograms, and biopsies. A distinct difference in the radiologic manifestation and clinical course of the infection was noted between the viable grafts and nonviable grafts. The viable grafts showed radiologic changes of osteomyelitis that were localized, and the graft incorporated, healed with antibiotics, and exhibited graft hypertrophy. In the nonviable grafts, the radiologic changes were extensive, evidence that resorption of the grafts had resulted. This suggests that, because of the poor prognosis associated with infection of the nonviable vascularized fibular grafts, the infected grafts should be removed early to minimize the morbidity and to shorten the protracted course associated with infection. With the infected viable grafts, efforts at salvaging the graft with multiple debridements and systemic antibiotics were rewarding.