Calcaneal osteomyelitis with Pseudomonas aeruginosa infection treated by Masquelet technique combined with vascularized free fibula flap: Two case reports

Abstract

The treatment of calcaneal osteomyelitis is challenging, and no effective treatment has been confirmed. In particular, Pseudomonas aeruginosa is resistant to many treatments and is associated with a high risk of amputation. The induced membrane technique has recently shown efficacy in treating osteomyelitis. In this paper, we present two cases of calcaneal osteomyelitis with Pseudomonas aeruginosa infection treated by the Masquelet technique combined with a fibular free flap. Case 1 involved a 25-year-old woman who developed calcaneal osteomyelitis following a calcaneal open fracture. Case 2 involved a 46-year-old man with paraplegia who developed calcaneal osteomyelitis secondary to a chronic skin ulcer. In the first stage of surgery, the necrotic bone and soft tissue were debrided, and a polymethylmethacrylate cement spacer was implanted into the bone defect. In the second stage of surgery, a free fibula flap was transplanted to the bone defect, and the peroneal artery and vein were anastomosed to the dorsal artery and saphenous vein. In Cases 1 and 2, the C-reactive protein concentration had decreased to normal by 21 and 36 days after surgery, respectively. Both patients showed no recurrence of osteomyelitis for >3 years of follow-up. The Masquelet technique involves the use of an induced membrane with neovascularization around the cement spacer. Drug delivery to the calcaneal region is considered to increase through this membrane, contributing to the suppression of Pseudomonas aeruginosa. The blood circulation in the free fibular flap is stable, contributing to wound healing.