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Reconstruction of large skeletal defects due to osteomyelitis with the vascularized fibular graft in children
Authors:Zalavras Charalampos G  Femino Dominic  Triche Rachel  Zionts Lewis  Stevanovic Milan
Affiliation:Department of Orthopaedic Surgery, Keck School of Medicine at the University of Southern California, Los Angeles County, CA, USA. zalavras@usc.edu
Abstract:
BACKGROUND: Reconstruction of large skeletal defects secondary to osteomyelitis is a challenging problem. The purpose of this study was to evaluate the outcome of the use of a vascularized fibular graft to treat such defects in children. METHODS: Eight patients with a mean age of seven years and a skeletal defect with a mean length of 11.8 cm (range, 6 to 17 cm) were treated with a vascularized fibular graft. A staged protocol was used for the five patients with an active infection at the time of presentation. The first procedure consisted of radical débridement, and at the second stage a free (seven patients) or pedicled (one patient) vascularized fibular graft was used. The mean follow-up time was 5.7 years. RESULTS: Union of the graft occurred primarily in seven of the eight patients, at a mean of 3.5 months, and after iliac crest bone-grafting in the remaining patient. There was no recurrence of deep infection. Complications developed in two patients. The mean time to full weight-bearing by the seven patients with a lower-extremity reconstruction was 8.4 months, and all patients were pain-free and able to walk without supportive devices. CONCLUSIONS: A vascularized fibular graft is a viable option for the management of large skeletal defects resulting from osteomyelitis in children.
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