Effects of sequential treatment of diabetic calcaneal osteomyelitis wounds with antibiotic bone cement and VSD combined with free chimeric anterolateral thigh perforator myocutaneous flaps

Zhong Yuhui; Cui Xu; Zhou Situo; Guo Le; Huang Mitao; He Zhiyou; Yang Haolin; Zeng Jizhang; Liang Pengfei; Zhang Pihong; Zhou Jie

doi:10.3760/cma.j.cn501225-20251129-00493

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Zhong Yuhui,Cui Xu,Zhou Situo,et al.Effects of sequential treatment of diabetic calcaneal osteomyelitis wounds with antibiotic bone cement and VSD combined with free chimeric anterolateral thigh perforator myocutaneous flaps[J].Chin J Burns Wounds,2026,42(3):1-9.DOI: 10.3760/cma.j.cn501225-20251129-00493.

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Effects of sequential treatment of diabetic calcaneal osteomyelitis wounds with antibiotic bone cement and VSD combined with free chimeric anterolateral thigh perforator myocutaneous flaps

doi: 10.3760/cma.j.cn501225-20251129-00493

1.
Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
2.
The Third Department of Surgery, Hunan Provincial Communications Hospital, Changsha 410011, China

Funds:

General Program of Hunan Provincial Natural Science Foundation 2025JJ50512

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Corresponding author: Zhou Jie, Email: zhoujie7812@sina.com
Received Date: 2025-11-29
Available Online: 2026-03-03

Abstract

Abstract

Objective To explore the effect of sequential treatment of diabetic calcaneal osteomyelitis wounds with antibiotic bone cement and vacuum sealing drainage (VSD) combined with free chimeric anterolateral thigh perforator myocutaneous flaps. Methods This study was a retrospective case series study. From June 2019 to June 2024, 12 patients with diabetic calcaneal osteomyelitis wounds meeting the inclusion criteria were admitted to the Department of Burns and Plastic Surgery of Xiangya Hospital of Central South University, including 7 males and 5 females, aged 40 to 65 years. There were 8 cases of Wagner grade Ⅲ wounds and 4 cases of Wagner grade Ⅳ wounds. In stage Ⅰ, debridement+temporary antibiotic bone cement filling and coverage+VSD treatment was performed, in which the wound area after debridement was 6 cm×5 cm to 18 cm×8 cm, and the bone defect volume was 1.0 cm×0.8 cm×0.5 cm to 1.8 cm×1.5 cm×0.8 cm. In stage Ⅱ, free chimeric anterolateral thigh perforator myocutaneous flaps were used to repair the wounds, in which the area of the perforator flap was 10.0 cm×5.0 cm to 20.0 cm×10.0 cm, and the area of the muscle flap was 3.0 cm×2.5 cm to 7.0 cm×6.0 cm. The wound at the flap donor site was directly sutured or repaired by split-thickness skin graft from the thigh. The white blood cell count, neutrophil, high-sensitivity C-reactive protein level, and microbial culture of wound secretion specimens at admission and 7 days after stage Ⅰ treatment, and the growth of wound bed granulation tissue 7 days after stage Ⅰ treatment were recorded. After stage Ⅱ surgery, the flap survival and the wound healing in the donor and recipient areas were observed. During follow-up, the blood supply, appearance, and texture of the recipient area flaps, whether ulcers and osteomyelitis recurred, the recovery of the donor areas, and the function of the affected limbs were observed. Results Seven days after stage Ⅰ treatment, the white blood cell count, neutrophil, and high-sensitivity C-reactive protein level of the patients were 7.15 (6.73, 8.70)×10⁹/L, 0.65 (0.63, 0.72), and 15.50 (12.48, 25.50) mg/L, respectively, which were significantly lower than 12.30 (11.28, 13.48)×10⁹/L, 0.80 (0.78, 0.83), and 73.20 (57.25, 93.75) mg/L at admission (with Z values of -2.905, -2.825, and -3.059, respectively, P values all <0.05). At admission, the microbial culture results of the wound secretion specimens were all positive, and the redness and swelling around the wound were obvious; 7 days after stage Ⅰ treatment, the microbial culture results of the wound secretion specimens were all negative, there was no obvious redness or swelling around the wound, and the wound bed granulation tissue grew well. After stage II surgery, only two patients had a small area of ischemic epidermal necrosis at the distal end of the flap, and the wounds achieved delayed healing after dressing changes; the flaps of the other patients all survived well and the wounds in the recipient areas all healed smoothly; the donor area wounds of all patients healed well. Follow-up for 6 to 18 months showed that the blood supply and appearance of the flaps were good, and the texture was soft; no recurrence of ulcers was observed, and no obvious signs of recurrence of osteomyelitis were shown by X-ray examination; the donor areas recovered well without obvious scar hyperplasia, and the affected limbs were all able to perform weight-bearing activities. Conclusions Sequential repair of diabetic calcaneal osteomyelitis wounds with antibiotic bone cement and VSD combined with free chimeric anterolateral thigh perforator myocutaneous flaps, on the basis of thorough removal of infected lesions, achieves effective closure of deep calcaneal dead space and soft tissue coverage. The short-term follow-up effect is good, and it is worthy of clinical promotion.
- Diabetic foot,
- Osteomyelitis,
- Negative-pressure wound therapy,
- Microsurgery,
- Anterolateral thigh perforator flap,
- Antibiotic bone cement,
- Chimeric flap,
- Wound repair

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References(44)

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