Department of Plastic and Reconstructive Surgery, University of Rome Sapienza, Rome, Italy.
J Plast Reconstr Aesthet Surg. 2009 Oct;62(10):e401-4. doi: 10.1016/j.bjps.2007.12.053. Epub 2008 Jun 11.
The goals of the treatment of chronic osteomyelitis are infection eradication with systemic antibiotic therapy and local management with radical excision of the infected tissue and obliteration of the remaining dead space. Adequate debridement and coverage with a well-vascularised tissue are mandatory for successful outcomes. Use of muscle covering for chronic osteomyelitis in the lower extremities is considered the best procedure. However, there have been instances where debridement of the bone tissue did not leave a deep cavity along the leg bones and fasciocutaneous flaps can be used in these instances to cover the defect and to restore function without recurrence of the disease. Recently, free non-muscle flaps have been used and assessed for chronic osteomyelitis or covering of exposed bone. Perforator flaps have been shown to be well vascularised due to a structural haemodynamic enhancement. In the light of these findings we report a successful case of chronic osteomyelitis of the right fibula treated with excision of the affected tissue and covering with a propeller flap. Instead of free flap covering, in order to optimise surgical reconstruction, reducing the operative time, donor and recipient site morbidity and risk of total flap failure, local perforator flaps and particularly the propeller flap may be indicated in the treatment of chronic osteomyelitis in selected patients when the defect is limited and there is no need to fill a deep bone cavity or a dead space. To our knowledge, this the first report of the use of a propeller flap in the treatment of chronic osteomyelitis in the lower extremities.
慢性骨髓炎的治疗目标是通过全身抗生素治疗根除感染，并通过彻底切除感染组织和消除残留的死腔来进行局部治疗。为了获得成功的结果，必须进行充分的清创和用富含血液的组织覆盖。在下肢使用肌肉覆盖物治疗慢性骨髓炎被认为是最佳方法。然而，有时在骨骼清创后，腿部不会留下深腔，在这种情况下，可以使用筋膜皮瓣来覆盖缺陷，并恢复功能，而不会使疾病复发。最近，已经使用游离非肌肉皮瓣来治疗和覆盖暴露的骨骼，并评估其用于慢性骨髓炎或暴露骨骼的效果。穿支皮瓣由于结构血液动力学增强而显示出良好的血供。鉴于这些发现，我们报告了一个成功的右侧腓骨慢性骨髓炎病例，采用切除受影响的组织并用螺旋桨皮瓣覆盖。为了优化手术重建，减少手术时间、供区和受区的发病率以及全皮瓣失败的风险，在特定患者中，当缺陷有限且无需填充深骨腔或死腔时，局部穿支皮瓣，特别是螺旋桨皮瓣，可能适用于治疗慢性骨髓炎。据我们所知，这是首例报告使用螺旋桨皮瓣治疗下肢慢性骨髓炎的病例。
