Effectiveness of free gracilis muscle flaps in the treatment of chronic osteomyelitis with purulent fistulas at the distal third of the tibia in children

J Pediatr Orthop. 2009 Apr-May;29(3):305-11. doi: 10.1097/BPO.0b013e31819903e1.


Background: Chronic purulent infection at the distal third of the tibia resulting from of a previous hematogenous osteomyelitis in children is a severe infection which is seldom reported in the literature and remains a difficult challenge for orthopaedic surgeons.

Methods: A 6-year retrospective review from September 2001 to October 2006 (institutional review board-approved) was performed to evaluate postoperative surgical results of this type of infection using a free gracilis muscle flap.

Results: A total of 6 children with an average age of 9.8 years were included. The infective period of purulent fistulas ranged from 6 to 31 months (mean 17.7). Staphylococcus aureus were reported in all wounds (6/6) and were commonly combined with Escherichia coli (5/6). All of the free gracilis muscle transfers were successful (6/6 flaps). No postoperative recurrence of infection was observed with an average postoperative follow-up period of 3 years. All patients were also able to satisfactorily demonstrate walking and standing functions.

Conclusions: Both the radical debridement of infected tissues and restoration of ample blood supply using free muscle flaps are the keys to success. Based on its favorable form, the free gracilis muscle flap can be considered a suitable muscle for use in reconstruction.

Level of evidence: IV.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bone Diseases, Infectious / etiology
  • Bone Diseases, Infectious / microbiology
  • Bone Diseases, Infectious / surgery*
  • Child
  • Chronic Disease
  • Debridement / methods
  • Escherichia coli / isolation & purification
  • Fistula / etiology
  • Fistula / microbiology
  • Fistula / surgery*
  • Follow-Up Studies
  • Humans
  • Male
  • Osteomyelitis / complications
  • Osteomyelitis / physiopathology
  • Osteomyelitis / surgery*
  • Recovery of Function
  • Retrospective Studies
  • Secondary Prevention
  • Staphylococcus aureus / isolation & purification
  • Surgical Flaps*
  • Tibia / microbiology
  • Tibia / pathology
  • Tibia / surgery
  • Treatment Outcome