Reconstruction Surgery Using Free Vascular Fibular Graft for Treating Chronic Osteomyelitis of The Forearm with Critical Bone Defect

A Case Report

Abstract

Chronic osteomyelitis causes severe morbidity and disability. Radical debridement of all infected tissue is the only way to eradicate the infection, which usually results in large bone defects. Treatment of skeletal defects secondary to osteomyelitis is a challenging problem. Advances in microsurgery have made possible the reconstruction of soft tissue and bone defects using free vascularized fibular grafts (FVFG). We present a ten years old girl with one year of neglected chronic osteomyelitis of right radius Cierny Mader type IIIA. The patient underwent two-staged surgery including debridement, sequestrectomy, external fixator application, and bone defect reconstruction using a free vascularized fibular graft. The patient showed no significant complications after the surgery. The functional outcome has a good result, although there is some limitation in pronation and supination. The radiographic outcome also showed satisfaction with the bone union. Two-staged surgery is safer when the infection area is extensive. FVFG is more resistant to infection because it is vascularized. FVFGs have very high bony union rates, resulting in limb preservation, pain relief, extremity stability, and satisfactory functional outcomes. The free vascularized fibular graft is a good reconstructive option for the management of infected long-bone defects in chronic osteomyelitis. FVFG fulfills most of the requirements from the aim of treatment in this kind of case.