Chimeric Free Fibula Osteocutaneus Flap and Massive Allograft for Refractory Post-traumatic Osteomyelitis Femur Defect: A Case Report.

Surgical management of femur osteomyelitis remains challenging. The burden of this chronic disease invariably results in composite bony and soft tissue defects that can interfere with bony stability. Therefore, reconstructive surgery is integral to functional limb salvage and limb preservatives. To the best of our knowledge, we are the first to report the limb salvaging method and important planning considerations for a case of chronic refractory osteomyelitis. We presented a case of a 31-year-old female with chronic post-traumatic osteomyelitis of the right femur. This intractable disease results in frequent remission of infection and non-union of the midshaft fracture. Surgical management with the implant, external fixation, and cement spacer failed due to infection. This rendered vascularised bone graft with massive allograft the only option. We described the anatomical aberrant during the harvest of free fibula flap and modified chimeric fibula flap to overcome the soft tissue defect complicated with severe fibrotic tissue with a background of an obese patient. She had undergone emergency hematoma evacuation 20 hours after the surgery. Otherwise, the flap survived well, and the patient started to have partial weight bearing. Chimeric fibula osteocutaneous free flap is a useful armament to provide a complex 3-dimensional spatial arrangement in a case of chronic osteomyelitis with huge bony and soft tissue defects.