Free Flap Treatment for Osteomyelitis

The treatment for osteomyelitis continues to be a challenge. There have been many advances, among which the use of free flaps seems to be a treatment alternative with relatively better results.

From February, 2000 to September, 2004 these authors used free flap techniques to treat six patients with osteomyelitis of the upper extremity at the Workers' Hospital in Santiago, Chile. They were all men between 25 and 57 years of age, treated after at least 3 months of disease, and all of them had positive cultures : 2 carpus osteomyelitis, 2 metacarpal osteomyelitis, 1 forearm osteomyelitis, and 1 elbow osteomyelitis. They were treated with extensive surgical debridement and resection of all jeopardized bone. After that, depending on the type of defect, the authors used 4 free serratus flaps, 1 free iliac crest, and 1 vascularized fibula graft.

Intravenous antibiotics were used just the day after surgery, and treatment of infection was successful in 5 cases. There was one case of recurrence which underwent new surgical debridement and structural bone graft.

The free flap seems to be an alternative which is a demanding but effective technique, and should be considered in the treatment of osteomyelitis.