A partially de-epithelized sural flap with a distal vascular pedicle in the treatment of distal tibial osteomyelitis
https://doi.org/10.25199/2408-9613-2022-9-2-12-17
Abstract
To cover a post-surgical bone defect is an essential part of successful treatment of osteomyelitis of long bones in addition to radical surgical treatment and osteonecrectomy. Autologic vascularized tissues is the best option to fill the infected bone defect. However, if a pathological focus is localized in the distal part of tibia, the deficit of surrounding soft tissues makes the replacement of infected tibial defect a difficult task. One of the ways to solve the discussed problem is application of de-epithelized part of fasciocutaneous sural flap with a distal feeding pedicle. The article describes specific features of this surgical technique and outcomes of treatment in three patients with post-traumatic osteomyelitis (type III by Czerny – Mader classification). Our experience allows us to recommend this technique for treating an infected cavity in the medullary canal of the distal part of tibia.
About the Authors
V. O. Tsvetkov
Sechenov University
Russian Federation
Russian Federation
Tsvetkov Vitaly Olegovich – Doctor of Medical Sciences, Head of Department of Surgery Postgraduate Institute.
2/4 Bol. Pirogovskaya Str., 119435, Moscow
O. V. Kolovanova
V.V. Vinogradov Moscow Municipal Hospital
Russian Federation
Russian Federation
Kolovanova Olga Viktorovna – Head of Purulent Surgery Department.
61 Vavilova Str., 117292, Moscow
A. M. Soloveva
Sechenov University
Russian Federation
Russian Federation
Soloveva Arina Mikhailovna – student Department of Surgery Postgraduate Institute.
2/4 Bol. Pirogovskaya Str., 119435, Moscow
E. A. Asriev
Peoples’ Friendship University of Russia
Russian Federation
Russian Federation
Asriev Egish Ashotovich – postgraduate student.
6 Miklukho-Maklaya Str., 117198, Moscow
References
1. Metsemakers W.-J., Fragomen A. T., Moriarty T. F., et al. Evidence-Based Recommendations for Local Antimicrobial Strategies and Dead Space Management in Fracture-Related Infection. J Orthop Trauma. 2020; 34 (1): 1829
2. Yang J., Yao J.-L., Wu Z.-Q., et al. Current opinions on the mechanism, classification, imaging diagnosis and treatment of post-traumatic osteomyelitis. Chin J Traumatol. 2021; 24 (6): 320–327.
3. Masquelet A. C., Romana M. C., Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg. Plast Reconstr Surg. 1992; 89 (6): 1115–1121.
4. Fodor L., Horesh Z., Lerner A., et al. The Distally Based Sural Musculoneu rocutaneous Flap for Treatment of Distal Tibial Osteomyelitis. Plast Reconstr Surg. 2007; 119 (7): 2127–2136.
5. Quang K. T., Brooks R. M. Reverse Sural Artery Adipofascial Flap: An Instructional Video. Plast Reconstr Surg Glob Open. 2020; 8 (11): e3253.
6. Wang C.-Y., Sun L.-Y., Chai Y.-M., et al. A “Hybrid” Sural Flap for Treatment of Chronic Calcaneal Osteomyelitis J Reconstr Microsurg. 2014; 30 (07): 457–462
7. Shtutin A. A., Mikhailichenko V. Yu., Shtutin I. A. Plasty of deep wound defects of the extremities with flaps with an axial type of blood supply = Shtutin A. A., Mikhaylichenko V. Yu., Shtutin I. A. Plastika glubokikh ranevykh defektov konechnostey loskutami s osevym tipom krovosnabzheniya. Meditsinskiy vestnik MVD. 2020; 4: 17–21. (In Russ.)
8. Tikhilov R. M., Kochish A. Yu., Rodomanova L. A., et al. Possibilities of modern methods of reconstructive plastic surgery in the treatment of patients with extensive post-traumatic de fects in limb tissues = Tikhilov R. M., Kochish A. Yu., Rodomanova L. A. i dr. Vozmozhnosti sovremennykh metodov rekonstruktivno-plasticheskoy khirurgii v lechenii bol’nykh s obshirnymi posttravmaticheskimi defektami tkaney konechnostey. Travmatologiya i ortopediya Rossii. 2011; 2 (60): 164–170. (In Russ.)
9. Afanasiev A. V., Afanasiev A. O., Tsybul E. S., Bozhkova S. A. The use of a sural flap in the surgical treatment of patients with chronic osteomyelitis of the leg = Afanas’yev A. V., Afanas’yev A. O., Tsybul’ E. S., Bozhkova S. A. Ispol’zovaniye sural’nogo loskuta pri khirurgicheskom lechenii patsiyentov s khronicheskim osteomiyelitom goleni. Meditsinskaya pomoshch’ pri travmakh. Novoye v organizatsii i tekhnologiyakh. Perspektivy importozameshcheniya v Rossii. Sbornik tezisov Pyatogo yubileynogo kongressa s mezhdunarodnym uchastiyem. 2020. S. 14–15. (In Russ.)
10. Opara K. O., Nwagbara I. C. The use of sural island musculofasciocutaneous flap, in the management of chronic osteomyelitis of the tibia. Niger J Clin Pract. 2018; 21 (6): 698–702.
11. Jin H. B., Kim K. S. Versatility of the reverse sural fasciocutaneous flap for the reconstruction of lower leg defects caused by chronic osteomyelitis. Archuiv Plast Surg. 2018; 45 (6): 601–604.
12. Al-Qattan M. M. The reverse sural artery fasciomusculocutaneous flap for small lower-limb defects: the use of the gastrocnemius muscle cuff as a plug for small bony defects following debridement of infected/necrotic bone. Ann Plast Surg. 2007; 59(3): 307–310.
13. Yang C., Geng S., Fu C., et al. A minimally invasive modified reverse sural adipofascial flap for treating posttraumatic distal tibial and calcaneal osteomyelitis. Int J Low Extrem Wounds. 2013; 12 (4): 279–285.
14. Cierny G., Mader J. T. Adult chronic osteomyelitis. Orthopedics. 1984; 7 (10): 1557–1564.
15. Gunawan B., Wijaya M. T., Pohan M. A. S. Reconstruction of tibial bone defect in new age using the old age Papineau technique: A case series. Ann Med Surg (Lond). 2019; 48: 109–114.
Review
For citations:
Tsvetkov V.O., Kolovanova O.V., Soloveva A.M., Asriev E.A. A partially de-epithelized sural flap with a distal vascular pedicle in the treatment of distal tibial osteomyelitis. Wounds and wound infections. The prof. B.M. Kostyuchenok journal. 2022;9(2):12-17. (In Russ.) https://doi.org/10.25199/2408-9613-2022-9-2-12-17
Views:
463
Email this article 