Lumbosacral reconstruction for intractable pyogenic spondylitis using a total leg flap with a vascularized tibia graft: Case report

Kentaro Iwakiri, Akira Miyauchi, Shinya Okuda, Ken Matsuda, Tomio Yamamoto, Motoki Iwasaki

    Research output: Contribution to journalArticlepeer-review

    2 Citations (Scopus)

    Abstract

    This report describes an effective technique of using a total leg flap for treating a 57-year-old male paraplegic patient with intractable sacral pyogenic spondylitis caused by methicillin-resistant Staphylococcus aureus. Spondylitis was accompanied by severe instability of the lumbosacral area, a large lumbosacral ulcer, and a large bone and muscle defect, which made it difficult for the patient to maintain a sitting position. A total leg flap procedure, a modification of the total thigh flap procedure, was performed as a 1-stage salvage surgery. The vascularized tibia and fibula were grafted between the lumbar and sacral vertebrae, and a musculocutaneous flap was used to cover the extensive ulceration in the lumbosacral skin defect. The intractable lesion of the lumbosacral spine, which had not been cured for more than 2 years despite repeated debridement, intravenous antibiotic injections, sugar treatment, pyoktanin treatment, and hyperbaric O2 treatment, subsided and stabilized within 1 year of surgery. The patient returned to activities of daily living using a wheelchair, and was very satisfied with the results. Use of a total leg flap with a vascularized tibia graft is an effective treatment for intractable pyogenic spondylitis accompanied by a large bone defect and large lumbosacral ulcers.

    Original languageEnglish
    Pages (from-to)468-472
    Number of pages5
    JournalJournal of Neurosurgery: Spine
    Volume8
    Issue number5
    DOIs
    Publication statusPublished - 2008 May

    Keywords

    • Pyogenic spondylitis
    • Spinal cord injury
    • Total leg flap
    • Vascularized bone graft

    ASJC Scopus subject areas

    • Clinical Neurology
    • Surgery
    • Neurology

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