A systematic review and meta-analysis of soft tissue reconstruction following debridement of tibial osteomyelitis: Comparing muscle and fasciocutaneous flaps.

[INTRODUCTION] Tibial osteomyelitis is a serious condition, often resulting from trauma or orthopedic surgery, frequently requiring soft tissue reconstruction after debridement. This systemic review and meta-analysis compared outcomes of muscle versus fasciocutaneous flap reconstruction following debridement of tibial osteomyelitis.

[METHODS] Following PRISMA guidelines, MEDLINE, EMBASE, PubMed Central, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched. Prospective or retrospective comparative studies evaluating muscle and fasciocutaneous flap reconstruction following tibial osteomyelitis debridement were included. Non-comparative studies with only one flap type were excluded to reduce bias. Primary outcomes included osteomyelitis recurrence and flap failure; secondary outcomes assessed amputation rates and patient satisfaction.

[RESULTS] Six studies encompassing 207 patients (219 flaps) were included. The meta-analysis showed a trend towards lower osteomyelitis recurrence rate in the fasciocutaneous flaps, although this was not statistically significant in one scenario (odds ratio [OR] 3.35, 95 % CI 1.14-9.90 and OR 2.69 95 % CI 0.93-7.74). Significant flap loss rates were comparable, with no statistically significant difference (OR 1.68 95 % CI 0.45-6.25 and OR 1.12 95 % CI 0.30-4.23). Amputation rates were similar between flap types (OR 3.06 95 % CI 0.46-20.38). One study reported higher satisfaction with fasciocutaneous flaps regarding appearance ( = 0.048).

[CONCLUSION] Both flap types effectively support reconstruction in tibial osteomyelitis, providing well-vascularized tissue to help reduce recurrence. Our study focused on the tibia, a bone particularly vulnerable to trauma and devascularization, and identified that muscle and fasciocutaneous flap coverage provided similar clinical outcomes.