Abstract
Aim
Vascularized fibula flap is one of the available options in the management of bone loss that can follow cases of severe haematogenous osteomyelitis. The aim of this study was to evaluate the outcomes of this procedure in a pediatric population in a Sub-saharan setting.
Method
The retrospective study focuses on the procedures done in the period between October 2013 and December 2016. Twenty-eight patients, 18 males and 10 females, were enrolled. The youngest was 2 years old, the oldest 13. The bones involved were tibia (13), femur (7), radius (5) and humerus (3). In 5 cases the fibula was harvested with its proximal epiphysis, whereas in 17 cases the flap was osteocutaneous and osseous in 6 cases. In most cases, operations for eradication of the infection were carried out prior to the graft. The flap was stabilized mainly with external fixators, rarely with Kirschner's wires or mini plate. No graft augmentation was used
Results
Graft integration was achieved in 24 cases. Three cases of early flap failure required the removal, while in one case complete reabsorption of the flap was noted a few months after the procedure. The follow-up period ranged from a minimum of 2 and half to a maximum of 6 years. Integration of the graft was obtained in a period of 4 months on average. The fibular flap with epiphysis had good functional outcomes with reconstruction of articular end. Early and delayed complications were observed. All grafts underwent a process of remarkable remodeling. No major problems were observed in the donor site, except for a transitory foot drop that resolved spontaneously.
Conclusions
Reconstruction of segmental bone defects secondary to hematogenous osteomyelitis with vascularized fibula flap is a viable option that salvages and restores limb function. It can be safely used even in early childhood. The fibula can be harvested as required by the local conditions. When harvested with a skin island, bone loss and poor soft tissues envelope may be addressed concurrently. The procedure is long and difficult but rewarding. When surgical skills and facilities are available, it can be carried out even in settings located in low resources countries.
