[Treatment of post-traumatic chronic calcaneal osteomyelitis and soft tissue defect by using combined muscle and skin flaps of calf].

OBJECTIVE: To investigate the effectiveness of distally pedicled peroneus brevis muscle flaps and reverse sural neurovascular island flaps for post-traumatic chronic calcaneal osteomyelitis and soft tissue defects.

METHODS: Between January 2008 and January 2012, 9 patients suffering from post-traumatic chronic calcaneal osteomyelitis and soft tissue defects were treated, including 8 males and 1 female with an average age of 33 years (range, 18-46 years). The left heel was involved in 4 cases, and right heel in 5 cases. Infection occurred after reduction and internal fixation of closed fractures of the calcaneus in 7 cases, and open calcaneal fracture and soft tissue defect in 2 cases. The disease duration was 2 months to 3 years (mean, 5 months). Purulent secretion, tissue necrosis, or sinus formation was observed in all wounds. The results of bacterial culture were positive. X-ray and CT examination showed uneven density of calcaneus and bone cavity or dead bone formation. After thorough debridement, the size of bone defect ranged from 3 cm x 3 cm x 3 cm to 6 cm x 4 cm x 3 cm; the size of soft tissue defect ranged from 7 cm x 3 cm to 12 cm x 7 cm. The distally pedicled peroneus brevis muscle flaps (11 cm x 3 cm-16 cm x 4 cm) were used for bone defect repair, and reverse sural neurovascular island flaps (8 cm x 4 cm-14 cm x 8 cm) for soft tissue defect. The donor site was directly sutured in 6 cases and repaired by skin graft in 3 cases.

RESULTS: After operation, reverse sural neurovascular island flaps survived in 9 cases, and all wounds healed by first intention. No necrosis or liquefaction of distally pedicled peroneus brevis muscle flaps was observed. Incision at donor site healed by first intention, and skin grafts at donor site survived. All cases were followed up 6-24 months (mean, 13.5 months). The flaps had good texture. No recurrence of osteomyelitis was observed. Basic weight-bearing walking function was restorated. No obvious calcaneal collapse happened.

CONCLUSION: The distally pedicled peroneus brevis muscle flap combined with reverse sural neurovascular island flap is one of the effective methods to treat post-traumatic chronic calcaneal osteomyelitis with soft tissue defect, with the advantages of simple operation and good blood supply.