Sural Artery Flap for the Treatment of Osteomyelitis of the Lower Leg

Soo Bong Hahn; Ho Jung Kang; Sun Young Joo

doi:10.4055/jkoa.2009.44.1.54

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Hahn, Kang, and Joo: Sural Artery Flap for the Treatment of Osteomyelitis of the Lower Leg

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2009; 44(1): 54-60.

Published online: 23 February 2009

DOI: https://doi.org/10.4055/jkoa.2009.44.1.54

Sural Artery Flap for the Treatment of Osteomyelitis of the Lower Leg

Soo Bong Hahn, M.D., Ho Jung Kang, M.D., Sun Young Joo, M.D.

Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea.

Address reprint requests to Sun Young Joo, M.D. Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, 134, Sinchon-dong, Seodaemun-gu, Seoul 120-752, Korea. Tel: +82.2-2228-2180, Fax: +82.2-363-1139, jsy9528@dreamwiz.com

Abstract

Purpose

We report our experiences with a sural artery flap for the treatment of soft tissue defects in the lower leg with osteomyelitis.

Materials and Methods

From 1998 to December 2004, 35 patients underwent sural artery flap surgery for soft tissue coverage in the lower leg. Among them, 13 cases also had osteomyelitis. The defects were located at the proximal 1/3 of the lower leg in 2 cases, middle 1/3 in 2 cases, and around the ankle in 9 cases. A distally based sural artery flap was performed in 11 cases, and 2 cases were treated with a proximally based sural artery flap.

Results

The size of the defects ranged from 3×3 cm to 15×10 cm. Two cases showed marginal superficial necrosis that required debridement and secondary closure. After an average follow-up period of 33 months, the osteomyelitis was cured in all cases without recurrence.

Conclusion

A sural arteriolized flap is useful for the treatment of osteomyelitis in the lower leg accompanied by a soft tissue defect.

Keywords: Soft tissue defect, Osteomyelitis, Sural artery flap

Figures and Tables

Fig. 1

(A) Radiograph taken 4 months after injury shows delayed union. (B) MRI shows enhancement in medullary canal and surrounding soft tissue. (C) Radiograph taken 3 years after operation shows well healing status of osteomyelitis without an evidence of recurrence.

Fig. 2

(A) 6×6 cm sized soft tissue defect with osteomyelitis on proximal third of lower leg. (B) Proximally based flap was designed. (C) Photograph taken 4 years after operation shows well healing status of osteomyelitis without an evidence of recurrence.

Table 1

Summary of Cases

^*S.aureus, Staphylococcus aureus; ^†S.epidermidis, Staphylococcus epidermidis.

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