Semiopen cancellous bone grafting. A 2 step method for closing small infected tibial bone defects.

Thirteen infected small tibial bone defects with overlying skin loss were treated with a 2 stage procedure. In the 1st stage, antibiotic impregnated polymethylmethacrylate bead chains were used to obliterate the debrided osseous cavity and a meshed porcine skin graft was used for temporary wound coverage. In the 2nd stage, the bead chains were replaced with autogenous cancellous bone graft, and the wound was again covered with a meshed porcine skin graft. All wounds and bone grafts healed without the need for an additional autogenous skin or bone graft. The patients were hospitalized an average of 23 days. The length of time to the completion of secondary epithelialization of the wound ranged from 2 to 5 months (average, 3 months). The length of time to bone union ranged from 5 to 8 months (average, 6.4 months). An additional application of porcine skin graft was required in 3 patients. Minor pin tract infections were seen in 2 patients. There was no recurrence of osteomyelitis during an average followup of 37 months (range, 24-54 months). This method was helpful in securing the closure of infected tibial bone defects with small skin losses and avoided both prolonged hospitalization and the morbidity usually accompanying free tissue transfer or the Papineau method of open cancellous bone grafting.