MANAGEMENT OF TIBIAL OSTEOMYELITIS: A TEN-YEAR REVIEW FROM A PLASTIC SURGERY PERSPECTIVE

Background Tibial osteomyelitis frequently requires plastic surgical input for effective long-term management, particularly where debridement results in bone or implant exposure. While orthopaedic and antimicrobial protocols are well established, reconstructive technique plays a critical role in minimising recurrence and preserving limb function. This study reviews 10 years of single-stage treatment at a bone infection centre. Methods A retrospective study of patients who underwent single stage tibial osteomyelitis debridement and reconstruction in a single bone infection centre from 2012-2024. Patient demographics, including age, gender, length of follow up were recorded. Reconstructive methods and outcomes including operative complications or recurrence of infections were reviewed. Results A total of 172 patients were identified (102 males, 70 females), with a minimum follow-up of six months. The average age was 54 years. Of the 172: 93 with free flaps, 61 with local flaps (55 muscle flaps and 6 fasciocutaneous), and 20 with direct closure or flap re-raise. In the free flap group, seven patients required urgent salvage procedures, four of which resulted in flap loss. Among the local muscle flaps, there were no partial or total flap losses. Of the six fasciocutaneous flaps, one flap loss and one experienced distal tip necrosis. There were no major complications in the direct closure group. Other complications—such as swelling and delayed wound healing—were observed in 9 patients across the entire cohort. Infection recurrence occurred in 15 patients (8.7%): 5 in the free flap group, 6 in the local flap group, and 4 in the direct closure group. Of these, three patients required amputation due to persistent infection; the remaining 12 were managed with re-debridement and further reconstruction Conclusion Plastic surgical reconstruction is central to the successful management of tibial osteomyelitis. While free flaps remain the mainstay for larger or complex defects, local flaps and direct closure can be safe and effective alternatives in selected cases.