Comparison of the clinical outcomes between the modified free musculocutaneous flap combined with delayed bone reconstruction technique and the free fasciocutaneous flap combined with Masquelet technique for post-traumatic osteomyelitis of the lower leg

OBJECTIVE: Post-traumatic osteomyelitis of the lower leg commonly involves severe infectious bone and soft tissue defects, posing significant reconstructive challenges and a high risk of infection recurrence. While both the free fasciocutaneous flap with Masquelet technique (FFCMT) and the modified free musculocutaneous flap with delayed bone reconstruction (MMDRT) have been described, their comparative efficacy remains unelucidated. This study aimed to evaluate and compare the clinical outcomes of FFCMT and MMDRT in managing such complex defects. METHODS: This retrospective cohort study included 45 patients with post-traumatic osteomyelitis of the lower leg who received MMDRT (22 cases) and FFCMT (23 cases) treatments at our hospital from January 2016 to August 2023. The demographic data, underlying diseases, ASA, bone and soft tissue defects, surgical data, and postoperative follow-up results of the two groups were documented for analysis. By comparing the bone union time, infection control efficiency, and postoperative complications of the patients in the two groups, the efficacy differences of the two surgical methods were systematically evaluated. RESULTS: The MMDRT group showed significant superiority over the FFCMT group in terms of bone union time (MMDRT:13.06 ± 1.14 months; FFCMT: 14.35 ± 1.01 months), the time for white blood cell and C-reactive protein indicators to return to normal, and the incidence of fracture-related complications (P < 0.05). However, there were no significant differences between the two groups in terms of the number of debridement procedures, operation time, blood loss, flap complications, and the final follow-up tibial healing RUST score and ankle AOFAS score (P > 0.05). CONCLUSION: The successful management of post-traumatic osteomyelitis hinges on effective infection control, coverage with well-vascularized tissue, and reconstruction of bone defects. While both MMDRT and FFCMT are effective for tibial osteomyelitis, MMDRT simplifies the bone grafting process, facilitating earlier infection control and shortening the fracture healing time.