Modified induced membrane technique using a non-vascularized fibular graft for chronic osteomyelitis of the metatarsal bone: A case report

The literature on the reconstruction of bone and soft tissue defects after chronic osteomyelitis in the foot remains limited. Reconstructing bones in weight-bearing areas of the foot is challenging, and the associated osteomyelitis and poor soft tissue conditions make the surgery even more difficult. The induced membrane technique (IMT) is used to treat segmental bone defects. However, IMT using a non-vascularized fibular graft for chronic osteomyelitis of the foot has rarely been reported. We aimed to present a case of a 70-year-old man who sustained an open fracture of the foot at the age of 18 years, with skin grafting. A scar and fistula were found on the medial side of the forefoot, exposing the first metatarsal bone. The patient was diagnosed with chronic osteomyelitis of the first metatarsal bone based on imaging findings. A modified IMT was used to reconstruct bone defects. The scarred skin, including the fistula and shaft of the first metatarsal bone, was removed, and a cement spacer was placed in the bone defect. The forefoot soft tissue defect was covered with a pedicled flap. After flap engrafting and maturation of the induced membrane, the bone defect was reconstructed using a non-vascularized fibular graft and cancellous bone. At the 2-year follow-up, the patient could walk but complained of mild pain around the forefoot without infection recurrence. Plain radiographs revealed graft union.

A non-vascularized fibular graft is easy to harvest and provides mechanical stability without the need for microsurgical techniques. Flap coverage and an induced membrane improved the vascularity around the bone defect site and created a soft tissue environment advantageous for bone union, even after chronic osteomyelitis. IMT with a non-vascularized fibular strut graft may be a potential solution for metatarsal bone reconstruction after chronic osteomyelitis.