[Treatment of osteomyelitis and soft tissue defects at distal region of leg and foot by pedicled peroneus brevis muscle flaps and reverse island flaps with sural nerve and blood supplying vessels].

OBJECTIVE: To observe the clinical effect of distally pedicled peroneus brevis muscle flaps and reverse island flaps with sural nerve and blood supplying vessels on repairing osteomyelitis and soft tissue defects at distal region of leg and foot.

METHODS: Twelve patients with osteomyelitis and soft tissue defects at distal region of leg and foot hospitalized from March 2008 to December 2010. Among them, 7 patients suffered from acute or chronic osteomyelitis and soft tissue defects at the distal end of tibia, 1 patient suffered from chronic osteomyelitis and chronic ulcer in the posterior aspect of achilles tendon, 4 patients suffered from acute or chronic osteomyelitis, soft tissue defects, and exposure of internal fixator in the lateral aspect of calcaneus. After debridement, soft tissue defect sizes ranged from 4 cm×2 cm to 13 cm×9 cm, and bone defect sizes ranged from 3.0 cm×3.0 cm×3.0 cm to 6.0 cm×3.0 cm×4.0 cm. The distally pedicled peroneus brevis muscle flaps with size ranging from 11 cm×3 cm to 16 cm×4 cm were used to fill the wound cavities of bone defects, and reverse island flaps with sural nerve and blood supplying vessels with size ranging from 5 cm×3 cm to 14 cm×10 cm were used for the repair of soft tissue defects. Flap donor sites were closed by direct suture or skin grafting.

RESULTS: Muscle flaps and flaps survived in 11 cases, and the wounds healed well. Necrosis appeared in flap and muscle flap at the distal end in one patient, which was repaired with posterior tibial artery perforator myocutaneous flap. Patients were followed up for 6 to 24 months. Osteomyelitis did not recur, and both the texture and shape of flaps were satisfactory.

CONCLUSIONS: The distally pedicled peroneus brevis muscle flaps and reverse island flaps with sural nerve and blood supplying vessels are suitable for the repair of osteomyelitis and soft tissue defects at distal region of leg and foot. The operation is simple, safe, reliable, and easy to perform.