ABSTRACT
Experience with infected pseudarthrosis with segmental osseous defect, treated by
debridement and microvascular bone transfer, is reported. Fourteen patients form the
basis for the study, including 12 males and two females. Patient age at the time of
operation averaged 35.1 years. Follow-up averaged 52 months. The affected site included
tibia (10), femur (2), and ulna (2). A total of 15 vascularized bone graft transfers
were carried out for the 14 patients, with the donor bone fibula (8) and ilium (7).
Bony union was ultimately obtained in all patients. In 11 patients, primary union
was obtained at both ends of the transferred bone segment. In the remaining three
patients, a secondary procedure, consisting of onlay nonvascularized bone autografting
at one end of the vascularized transferred bone segment, was required to obtain union.
Recurrent infection following union occurred in one patient. One of the two patients
with active osteomyelitis at the time of vascularized bone transfer had complications
from recurrent sepsis, leading to the authors' caveat that vascularized bone transfer
should be deferred until such time as sepsis is inactive. Criteria used in this series
for determining inactive sepsis (absence of sinus tracts, negative bacterial cultures,
negative c-reactive protein, and a sedimentation rate of less than 15 mm per hour)
seem appropriate.
The study suggests that vascularized bone transfer is a useful procedure for the treatment
of infected segmental osseous defects of long bones, of more than 3 cm extent and
one month or more after inactive sepsis.
