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Reconstruction of Large Skeletal Defects Due to Osteomyelitis with the Vascularized Fibular Graft in Children

¹ Department of Orthopaedic Surgery, Keck School of Medicine at the University of Southern California, Los Angeles County and University of Southern California Medical Center, 1200 North State Street, GNH 3900, Los Angeles, CA 90033. E-mail address for C.G. Zalavras: zalavras{at}usc.edu
² Childrens Hospital Los Angeles, 4650 Sunset Boulevard, M/S 69, Los Angeles, CA 90027
³ Women's and Children's Hospital, Room 3L-31, 1240 North Mission Road, Los Angeles, CA 90033

Investigation performed at Los Angeles County and University of Southern California Medical Center, and Childrens Hospital Los Angeles, Los Angeles, California

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

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.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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