Management of large infected tibial defects with antibiotic beads local therapy and staged fibular osteoseptocutaneous free transfer

Steve Wen Neng Ueng*, Fu Chan Wei, Chun-Hsiung Shih

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

40 Scopus citations

Abstract

Fifteen patients with tibial fractures complicated by large infected tibial defects were treated with a two-stage protocol. In the first stage, antibiotic-impregnated polymethylmethacrylate bead chains were used to obliterate the debrided osseous defect, and a meshed porcine skin was used for temporary wound coverage. In the second stage, the bead chains were removed, and the defects were reconstructed with a microvascularized fibular osteoseptocutaneous free transfer. The time between the first and second stages of treatment was 2 to 6 weeks. The bone defects ranged from 6 to 16 cm, and the skin defect areas ranged from 10 to 82 cm2. Wound healing and bony union were achieved in all 15 cases. An additional muscle flap or skin graft was required for only three patients with a large skin defect. Minor pin tract infections were seen in two patients. Stress fractures in three cases were successfully managed with bracing, external skeletal fixation or plating, and cancellous bone grafting. All of the most recent roentgenograms showed good consolidation and hypertrophy of grafted fibular bones. No recurrence of osteomyelitis was observed during an average follow-up period of 50 months (range, 36-86 months). We therefore conclude that this treatment protocol provides rapid recovery from osteomyelitis. The fibular osteoseptocutaneous graft is a useful method for the reconstruction of a large tibial defect, and it also offers the unique advantage of simultaneously reconstructing a moderate skin defect.

Original languageEnglish
Pages (from-to)268-274
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume43
Issue number2
DOIs
StatePublished - 08 1997
Externally publishedYes

Fingerprint

Dive into the research topics of 'Management of large infected tibial defects with antibiotic beads local therapy and staged fibular osteoseptocutaneous free transfer'. Together they form a unique fingerprint.

Cite this