Vascularized Fibular Grafts in the Treatment of Osteomyelitis and Infected Nonunion

From 1976 to 1989, 33 patients with osteomyelitis and infected nonunion of lower extremity bones were treated with vascularized fibular grafts. There were 30 males and three females, and the ages at operation ranged from 17 to 69 years. There were 24 tibial lesions and nine femoral lesions. The fibular graft was performed immediately after lesional debridement in eight patients, but in 25 it was done secondarily after debridement and successful subsidence of inflammation. The mean interval between the last debridement and fibular grafting was ten weeks. Thirty of 33 grafts survived. The mean periods required to obtain radiographic bone union was 6.2 months at the proximal site and 6.3 months at the distal site. Local recurrence of infection occurred in four patients; all but one healed well with saucerization. Vascularized fibular graft is an effective procedure for the treatment of destructive osteomyelitis and infected nonunion.