The efficacy of free tissue transfer in the treatment of osteomyelitis

We evaluated the efficacy of free tissue transfer in the treatment of osteomyelitis in 33 patients who were followed for an average of 41.4 months (range, 24 to 59 months). The bone lesions were classified in two ways: first, according to whether there had been drainage for less or more than 6 months and second, according to whether the lesion was Type I, II, or III. The 33 patients underwent a total of 37 free tissue transfers, and 30 (79%) of the transfers survived. Major complications were encountered after 41% of the surgical procedures, consisting of failure of the free tissue transfer in 7 patients (21%) and recurrent sepsis in 6 (20%) at follow-up. Four of the 7 patients in whom the free tissue transfer failed underwent an amputation. Six of the patients with a failed transfer and 9 of the 10 with recurrent sepsis had a Type-III lesion. Previously published reports have suggested that free tissue transfer is an extremely successful and reliable procedure for the treatment of osteomyelitis. In our series limited success was achieved in patients with a Type-I or II lesion, but 6 of the patients with a Type-III lesion had recurrence of infection despite a successful transfer.