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 thirty-three patients who were followed for an average of 41.4 months (range, twenty-four to fifty-nine months). The bone lesions were classified in two ways: first, according to whether there had been drainage for less or more than six months and second, according to whether the lesion was Type I, II, or III. The thirty-three patients underwent a total of thirty-seven free tissue transfers, and thirty (79 per cent) of the transfers survived. Major complications were encountered after 41 per cent of the surgical procedures, consisting of failure of the free tissue transfer in seven patients (21 per cent) and recurrent sepsis in six (20 per cent) at follow-up. Four of the seven patients in whom the free tissue transfer failed underwent an amputation. Six of the patients with a failed transfer and nine of the ten 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 six of the patients with a Type-III lesion had recurrence of infection despite a successful transfer.