Muscle Pedicle Grafting for Failed Treatment of Chronic Tibial Osteomyelitis: A Retrospective Case Series Analysis

Abstract

Gaurav Jain*, Manish Bajaj, Anshul Meena

Background: Chronic tibial osteomyelitis unresponsive to initial surgical and antimicrobial interventions remains a challenging clinical problem. This study evaluates the role of local muscle pedicle flaps as a salvage reconstructive strategy in patients with failed primary treatments including debridement, Ilizarov external fixation, antibiotic-loaded spacers (Stimulan beads), and masquerade procedures.

Methods: Retrospective review of 14 consecutive patients with chronic, recalcitrant tibial osteomyelitis treated with muscle pedicle flap reconstruction between January 2018 and December 2024 at LNCT Medical College, Indore. All patients had undergone at least one failed primary surgical intervention prior to flap coverage. Demographic, clinical, microbiological, radiological, and outcome data were analyzed.

Results: Fourteen patients (10 male, 4 female; mean age 41.2 ± 14.6 years) with mean infection duration of 34.8 ± 18.4 months underwent muscle pedicle flap reconstruction as salvage procedure. Prior failed interventions included: Ilizarov fixation (85.7%), repeated debridement (100%), stimulan beads (57.1%), and masquerade procedures (35.7%). Clinical improvement was achieved in 11 of 14 cases (78.6%). Complications included: Flap failure in 1 case (7.1%) requiring amputation, late recurrent infection in 1 case (7.1%), and conversion to Ilizarov in 1 case (7.1%). Complete infection eradication: 71.4% (10/14). Limb salvage rate: 85.7% (12/14). CRP declined from 71.4 ± 22.3 to 24.6 ± 18.9 mg/L (p<0.001).

Conclusion: Muscle pedicle flaps provide a reasonable salvage option for recalcitrant tibial osteomyelitis, achieving limb salvage in 85.7% of cases. However, success rates are substantially lower than in primary reconstruction, with significant complications and recurrent infection rates. Realistic patient counseling regarding expectations is critical.