Limb salvage in advanced chronic osteomyelitis in children

Chronic osteomyelitis of the entire tibial shaft was treated in 9 children by medical and surgical management in 3 stages. In stage 1, the involved shaft was excised with debridement of the periosteum. Stage 2 consisted of continuous suction-irrigation of the periosteal space with local and systemic antibiotics. In stage 3, the ipsilateral fibular shaft was transferred into the tibial periosteal envelope with the muscles of the middle third and its blood supply. After 18 months, the transferred fibula grew into a new tibia in every case so that the children were able to carry out all their activities of daily living. This method remains the best way of salvaging the limb when the entire tibia is involved.