Treatment of tibial intramedullary osteomyelitis using removable antibiotic coated cement rods and an adipofascial perforator flap: A case report

Abstract

Intramedullary osteomyelitis in diabetic patients yields a poor prognosis. These conditions frequently can lead to major amputation due to the complex nature of the pathology and limited effective treatment options. Here, we present our limb salvage plan in a 63 year old female suffering from an equinovarus right ankle which was complicated by wound dehiscence and intramedullary osteomyelitis following an ankle and subtalar arthrodesis.Our treatment plan involved the use of multiple temporary antibiotic coated cement rods and an adipofascial posterior tibial artery perforator turndown flap. Our technique utilized a hybrid of the short term use of PMMA beads with the stability of a rod in a removable antibiotic coated rod with a post that allowed for biweekly rod replacement while maintaining high concentrations of antibiotic. The use of a perforator flap allowed a wider degree of freedom regarding the size and shape of the graft. It also preserved the vascularity of the graft which promoted antibiotic delivery and healing to the defect. The combination of multiple limb salvage techniques allowed for eradication of infection while providing vascularized soft tissue coverage and a functional plantigrade foot.

Keywords

• Chronic wound
• Antibiotic cement rod
• Perforator flap
• Intramedullary osteomyelitis
• Case report