Severe Forearm Osteomyelitis Management with Microvascular Fibular Flaps.

Severe infections at the forearm level are difficult to treat not only in terms of sterilization but also in terms of functional restitution. Traditional radical debridement is very important, and sometimes the reconstruction of the excised tissues it s difficult with conventional techniques. At the forearm level, local flaps generally are not sufficient in covering big defects. Conventional bone grafts may be resorbed or they cannot help healing when placed in infected and hypovascular tissue bed. Therefore, bone reconstruction is a real challenge. Development of microsurgical techniques has increased the possibilities of treatment when those severe infections occur. Re- construction of large soft tissue defects can be achieved by choosing the appropriate free flap. Vascularized fibular grafts allow the use of a segment of diaphyseal bone which is structurally similar to the radius and the ulna, and of length that would suffice to reconstruct most skeletal defects. In the upper limbs the vascularized fibular graft is indicated for patients in whom conventional bone grafting has failed or large bone defects are p- resent (extending beyond 5 cm). When contemporary soft tissue reconstruction is needed, the fibula may give osteocutaneous and osteomyocutaneous grafts to be transferred. We report the results of a series of 22 cases of severe chronic osteomyelitis of the radius and/or the ulna treated with free vascularized fibula bone grafts. All patients were reviewed at a mean follow-up of 3 years (10-93 months); in all cases the infection never re- curred.We report only one bone resorption, in the case of a double-barrel fibular transfer, which probably oc- curred due to vascularization failure. Even in this case, the patient was able to resume previous occupation.