[Treatment of chronic osteomyelitis of the tarsal bones with free muscle flaps].

Although the value of free muscle flaps in the treatment of chronic osteomyelitis of the lower leg is well documented, only few reports deal with the use of free muscle flaps for treatment of osteomyelitis of the tarsal bones. Four patients with chronic osteomyelitis of the tarsal bones (in three patients several bones were involved) were treated using the following regimen: radical debridement, coverage with a free muscle flap, and systemic antibiotic therapy. In two patients, infection recurred following primary transplantation of the muscle flap. In one of these patients, recurrence was controlled by repeating the same regimen. In the other patient, debridement was repeated and the calcaneus was transposed to obliterate the resultant bone cavity. At follow-up (mean 19 months following last surgical procedure), all four patients showed no evidence of infection and were fully weight-bearing. Chronic osteomyelitis of tarsal bones can be successfully treated by radical debridement and coverage with muscle flaps, even in advanced stages of the disease. The clinical and anatomical peculiarities of this region, however, have to be taken into consideration.