The Journal of Bone and Joint Surgery, Vol 70, Issue 3 377-386, Copyright © 1988 by Journal of Bone and Joint Surgery, Inc
Treatment of infected non-unions and segmental defects of the tibia with staged microvascular muscle transplantation and bone-grafting
L Gordon and EJ Chiu
Department of Orthopaedic Surgery, University of California, San Francisco 94143-0728.
Fourteen patients who had an infected non-union or segmental defect of the
tibia were treated with debridement and microvascular transplantation of
muscle. Successful free muscle transplantation and control of the infection
were achieved in all patients. The prognosis was, in general, related to
the severity of the underlying osseous problems, which were categorized
into types A (a tibial defect and non-union without significant segmental
loss), B (a tibial defect that is more than three centimeters long and an
intact fibula), and C (a tibial defect that is more than three centimeters
long, involving both the tibia and the fibula). All of the six type-A
patients healed without needing bone-grafting. Of the four type-B patients,
all of whom had subsequent bone-grafting, reactivation of the infection
occurred in two, and both ultimately had a below-the-knee amputation; the
third patient had a non-union between the fibular graft and the tibia; and
the fourth patient was fully weight-bearing. All of the four type-C
patients also required subsequent bone-grafting; all finally healed and
were able to walk with a brace. The results in the present series indicate
that, in patients who have an infected tibial defect or non-union,
including those that are so severe that an amputation might be considered,
this method of treatment is a valid option for salvage of the limb.
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