Muscle versus nonmuscle flaps in the reconstruction of chronic osteomyelitis defects

Surgical treatment of chronic osteomyelitis requires aggressive debridement followed by wound coverage and obliteration of dead space with vascularized tissue. Controversy remains as to the effectiveness of different tissue types in achieving these goals and in the eradication of disease.Chronic osteomyelitis was induced in 26 goat tibias using Staphylococcus aureus as an infecting inoculum. In a single stage, debridement followed by reconstruction using either a muscle flap (n = 13) or a fasciocutaneous flap (n = 13) was performed. Flap donor sites were closed primarily and antibiotics were given for 5 days postoperatively. Daily clinical evaluation for 1 year was performed and monthly radiographs were obtained for 9 months and 1 year after the reconstruction.Twenty-five flaps survived completely, and one nonmuscle flap underwent partial flap loss following a period of venous congestion. There were no postoperative complications in the muscle flap group. Two goats (15 percent) in the nonmuscle group developed superficial wounds in the immediate postoperative period that resolved with conservative management. No limbs had recurrent osteomyelitis wounds at 1 year of clinical follow-up examination. Radiographic evidence of osteomyelitis was present in two goats (15 percent) in the muscle group and one goat (8 percent) in the nonmuscle group. There was no statistically significant difference in the incidence of recurrent osteomyelitis between the groups by clinical and radiographic assessment.The findings in this study demonstrate that vascularized tissue flaps in the form of muscle or nonmuscle flaps provide viable options for wound coverage of osteomyelitis defects following adequate surgical debridement.