| Summary: | <p>Chronic bone infections often present with complex bone and soft tissue
loss. Management is difficult and commonly delivered in multiple stages over
many months. This study investigated the feasibility and clinical outcomes
of reconstruction in one stage.</p>
<p>Fifty-seven consecutive patients with chronic osteomyelitis (<span class="inline-formula"><i>n</i>=27</span>) or
infected non-union (<span class="inline-formula"><i>n</i>=30</span>) were treated with simultaneous debridement,
Ilizarov method and free muscle flap transfer. 41 patients (71.9 %) had
systemic co-morbidities (Cierny-Mader group Bs hosts). Infection was
confirmed with strict criteria. 48 patients (84.2 %) had segmental
defects.</p>
<p>The primary outcome was eradication of infection at final follow-up.
Secondary outcomes included bone union, flap survival and complications or
re-operation related to the reconstruction.</p>
<p>Infection was eradicated in <span class="inline-formula">55∕57</span> cases (96.5 %) at a mean follow-up of 36 months (range 12–146). No flap failures occurred during distraction but 6
required early anastomotic revision and 3 were not salvageable (flap failure
rate 5.3 %).</p>
<p>Bony union was achieved in <span class="inline-formula">52∕57</span> (91.2 %) with the initial surgery alone.
After treatment of the five un-united docking sites, all cases achieved bony
union at final follow-up.</p>
<p>Simultaneous reconstruction with Ilizarov method and free tissue transfer is
safe but requires careful planning and logistic considerations. The outcomes
from this study are equivalent or better than those reported after staged
surgery.</p>
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