| Summary: | <p><strong>Background</strong>: Hematogenous osteomyelitis is commonly observed in the
pediatric population across sub-Saharan Africa. This retrospective case
series was designed to evaluate the complications and outcomes of treatment
using a vascularized fibula flap (VFF) to fill segmental bone defects
secondary to osteomyelitis in children in a low-resource setting in CoRSU
Rehabilitation Hospital, Uganda.
<strong>Methods</strong>: Clinical notes and radiographs of children with a
diagnosis of osteomyelitis that subsequently underwent a VFF procedure
between October 2013 and December 2017 were reviewed. All patients were
clinically and radiographically evaluated in 2019.
<strong>Results</strong>: Forty-four children, with an average bone defect of 10.5 cm, were included. Eighty-four percent of children had successful VFF limb
reconstruction. Integration of the graft was radiologically sound in 20.8 weeks on average. The postoperative phase was uneventful in 29 % of
patients. Complications were observed in the remaining patients, including
flap failure (6), donor leg neurapraxia (3), cutaneous paddle necrosis (11),
graft fracture (2), skin graft loss (6), fixator failure (1) and non-union (2). Functional outcomes were rated as excellent in 13 patients, good in 14,
fair in 9 and poor in 8. There was no recurrence of the bone infection in
any of the enrolled children.
<strong>Conclusion</strong>: Despite being a complex and demanding procedure, VFF is
a good option for reconstructing post-osteomyelitis bone defects,
particularly when associated with loss of soft tissue envelope. Considering
the more than satisfactory functional and clinical outcomes, this procedure
should be kept in mind for these complex pediatric cases of bone and soft
tissue loss, even in a low-resource setting.</p>
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