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. 2024 May 24;12(5):e5837.
doi: 10.1097/GOX.0000000000005837. eCollection 2024 May.

Free Vascularized Fibula Graft as Primary Salvage Procedure for Acute Cervical Osteomyelitis Caused by Epidural Abscess

Timothy A Ciosek  1   2 , Andreas Sørlie  3   4 , Jens Munch-Ellingsen  3   4 , Tore K Solberg  3   4 , Sven Weum  2   5 , Louis de Weerd  1   2
Affiliations

Free Vascularized Fibula Graft as Primary Salvage Procedure for Acute Cervical Osteomyelitis Caused by Epidural Abscess

Timothy A Ciosek et al. Plast Reconstr Surg Glob Open. .

Abstract

Acute cervical osteomyelitis due to an epidural abscess and pyogenic spondylodiscitis in an immunosuppressed patient with progressive myelopathy is a challenge for the reconstructive surgeon. This report presents our novel approach to treat such a condition in a 56-year-old patient in whom antibiotic treatment and decompression of the medulla by laminectomy of C4-C6 failed. Under general anesthesia, debridement of all infected tissue, including anterior corpectomy of C4-C6, was performed. Simultaneously, a free vascularized fibula graft (FVFG) was harvested, adapted to the bone defect, and anastomosed to the superior thyroid artery and external jugular vein. The graft was stabilized with an anterior plate. A scheduled posterior stabilization was performed 1 week later. Staphylococcus aureus was cultured from bone samples and was treated with antibiotics. The postoperative course was uncomplicated besides a dorsal midline defect 6 weeks postoperatively that was closed with a sensate midline-based perforator flap. Five years on, the patient is infection free, and regular control computed tomography and magnetic resonance imaging scan images show progressive fusion and hypertrophy of the fibula to C3/C7 vertebrae. An FVFG combined with posterior stabilization could be a promising primary salvage procedure in cases with progressive myelopathy caused by acute cervical osteomyelitis due to spinal infection. The FVFG contributes to blood circulation, delivery of antibiotics, and an immunological response to the infected wound bed and can stimulate rapid fusion and hypertrophy over time.

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Conflict of interest statement

The authors have no financial interest to declare in relation to the content of this article. This study was supported by a grant from the publication fund of UiT, The Arctic University of Norway.

Figures

Fig. 1.
Fig. 1.
The CT scan image taken the preoperative day shows collapse of infected vertebrae bodies of C3, C4, and C5, causing a kyphotic deformity leading to progressive myelopathy and pain.
Fig. 2.
Fig. 2.
The harvested FVFG before its size is reduced to fill the defect.
Fig. 3.
Fig. 3.
The CT scan image showing the coronal projection of the FVFG fixated with the anterior plate after 5 years.
Fig. 4.
Fig. 4.
The CT scan image showing the sagittal projection of the FVFG fixated with the anterior and posterior plate at 5 months.
See this image and copyright information in PMC

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