Use of Anterolateral Thigh Perforator Flaps for Chronic Osteomyelitis of the Lower Extremity

From April, 2000 to January, 2005, 46 consecutive patients with chronic osteomyelitis of the lower extremity underwent surgical debridement and reconstruction with anterolateral thigh perforator flaps (8 cases were combined with vastus lateralis muscle flaps). All wounds were open for a minimum period of 6 weeks (average of 17 months; range from 6 weeks to 59 months). The average patient age was 44 years (ranged from 18 to 71 years), there were 35 males and 11 females, and the average follow up period was 21.5 months (ranged from 3 to 53 months). The cause of injury was an open fracture in 10 cases, secondary wound complications after reduction in 21 cases, and diabetic foot in 15 cases. Surface defects ranged from 50 to 201 cm². Wounds were debrided an average of 2.5 times, then reconstructed with flaps and treated with antibiotics for 6 weeks. Antibiotic beads were used in 6 cases and secondary bone graft procedures were performed in 14 cases 3 months after flap coverage.

All 46 flaps were successful without any signs of recurrences or persistent osteomyelitis. Partial wound dehiscence was observed during early rehabilitation in two cases suspected of delayed healing caused by diabetes. They healed spontaneously. All patients achieved acceptable gait function after rehabilitation. No debulking procedure was necessary in any case.

Although the muscle flap is known to provide superior vascular supply, the type of flap used for coverage seems to be less critical in the final outcome, providing that total debridement and obliteration of dead spaces are achieved. A wel- vascularized anterolateral thigh perforator flap was successfully used to combat infection and bring stability to wounds with chronic osteomyelitis.