The Efficacy of Perforator Flaps in the Treatment of Chronic Osteomyelitis

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Abstract

Background:

Treatment of chronic osteomyelitis involves aggressive débridement followed by soft-tissue coverage. The dictum of muscle coverage being superior has been challenged by successful reports of coverage with skin flaps. The objective of this article is to evaluate the efficacy of perforator flaps for reconstruction of chronic osteomyelitis defects.

Methods:

A retrospective review of 120 patients with chronic osteomyelitis who underwent débridement and reconstruction using perforator flaps from April of 2000 to November of 2015 was conducted. Inclusion criteria were cases with chronic osteomyelitis for a minimum of 6 weeks and with a follow-up of at least 2 years after surgery. Correlation between recurrence and the following factors was analyzed: comorbidities, frequency of débridement, duration of chronic osteomyelitis, limb vascular status, and method of dead space obliteration. The outcomes analyzed were flap loss, recurrence rate, primary remission rate, secondary remission rate, and amputation rate.

Results:

The flap loss rate was 4.2 percent flap, the recurrence rate was 8.3 percent, the primary remission rate was 91.6 percent, the secondary remission rate was 98.3 percent, and the amputation rate was 1 percent. Significant predictors of recurrence were peripheral vascular disease and major vessel compromise, which had 5.1 times higher odds of recurrence (p < 0.05).

Conclusions:

Used with adequate débridement, bone reconstruction, and obliteration of dead space, a primary remission rate of 91.6 percent and a secondary remission rate of 98.3 percent were achieved using perforator flap. The predictors of chronic osteomyelitis recurrence were peripheral vascular disease and major vascular compromise.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.

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