The use of sural Island musculo fasciocutaneous flap, in the management of chronic osteomyelitis of the tibia

Abstract

Background: The management of soft‑tissue defects following surgery for chronic osteomyelitis of the tibia is challenging. It often requires complex reconstructive procedures, especially when the distal third of the tibia is involved. We present a relatively simple method of addressing these defects.

Aim: This study aims to report our experience with the use of the sural Island musculo fasciocutaneous flap in the management of osteomyelitis of the tibia.

Materials and Methods: Consecutive patients with osteomyelitis of the tibia requiring soft‑tissue cover were managed using the sural Island musculo fasciocutaneous flap, and the outcome was analyzed. The study was prospective in nature.

Results: There were 21 patients, 15 males and 6 females. Their ages ranged from 21 years to 62 years. Most (71%) were in the 3^rd and 4^th decades of life. Twelve patients had involvement of the distal third of the tibia, eight involved the middle third, while five patients had involvement of the proximal third. Most of the patients (17) developed osteomyelitis following open fractures of the tibia; thirteen of these were from road crashes and four from gunshot injuries. Four patients developed osteomyelitis through the hematogenous route. Flap sizes ranged from 8 × 7 cm to 16 × 11 cm. There was tip necrosis in 2 flaps and full survival in 19 flaps. The flaps with partial necrosis were managed by simple dressing. Fifteen patients (71%) had cessation of drainage within 4 weeks of surgery. Two patients presented with recurrence of infection within the period of follow‑up. Mean follow‑up period was 23 months. All donor sites were skin grafted primarily, with 95%–100% graft take.

Conclusion: The sural Island musculo fasciocutaneous flap is a reliable source of richly vascularized soft tissue for the management of dead space and soft‑tissue defects in chronic osteomyelitis of the tibia. It has the added advantage of providing sizeable tissue, with good reach to all segments of the tibia.

Keywords: Chronic, osteomyelitis, sural musculo fasciocutaneous flap, tibia