Refinements in the one-stage procedure for management of chronic osteomyelitis

Posttraumatic osteomyelitis remains a frequent problem and requires aggressive surgical treatment to be cured. Radical debridement of all involved soft and hard tissues, obliteration of dead space, and neovascularization of the involved area are obligatory for successful management of the disease. Microvascular free tissue transfer provides the necessary tissue bulk and neovascularization to reconstruct the resulting defect. The transplanted muscle can be optimally mobilized and adjusted in size to obliterate the dead space in contrast to local transposition flaps. This is facilitated by smoothening the bony cavity using a rotating drill system. With an optimal interface between the muscle and the wall of the cavity, small foci of infection can be eliminated. Moreover after free muscle transfer, the optimal environment for secondary bone reconstruction is created. These principles of radical debridement combined with muscle transfer for dead space obliteration, are generally accepted in literature. Nevertheless to achieve this goal several different treatment schedules of repetitive debridements, prolonged antibiotic regimes, and finally various flap transfers have been advocated. We present 16 patients with chronic osteomyelitis treated with radical debridement and immediate free muscle transfer using the latissimus dorsi muscle preferably. Postoperatively an antibiotic course of only 12 days was given. With a mean follow-up of 2 years all patients remained symptom free. Therefore, our results indicate that this long-term problem can be solved by a one-stage procedure using a free flap combined with a short course of antibiotics. However definite conclusions should be reserved for 20 years.