Vascularized partial first metatarsal transfer for the treatment of phalangeal osteomyelitis

The author reports the salvage of the index finger in a patient with extensive osteomyelitis of the proximal phalanx. Salvage was achieved by a staged reconstruction, using external fixation combined with aggressive debridement, and an antibiotic/methylmethacrylate spacer, followed by a vascularized bone flap from the first metatarsal. Union was achieved with an excellent functional outcome of 205 degrees of total active motion. The literature addressing the management of osteomyelitis in this particular location is incomplete. This author believes that loss of a large portion of the diaphysis is difficult to treat by conventional bone grafting because of the poorly vascularized bed following extensive infection. The case reported is unique because of the choice of donor site. Vascularized bone grafting is suggested as offering the best chance for success, and the donor-site material can be easily tailored to fit the phalangeal defects.