Dolph Houben

47 Vascularized Bone Grafts, a closer look at the free fibula flap 2 Figure 6 : A stress fractured occurred after the reconstruction of a large tibia defect with a free vascularized fibula. This radiograph shows the normal healing process of the fracture due to the maintained tissue viability of the vascularized fibula flap. Infection Osteomyelitis is one of the second most frequent indications for vascularized bone transfer [1] . The outcome of these patients is less satisfactory. Experience with a series of 60 patients who had a vascularized bone transfer for osteomyelitis demonstrated an increased potential for several complications. These complications include reactivation of the infection (18%), occasionally leading to amputation(17%), and non-union(6%) [1] . To prevent reactivation of the infection vascularized bone transfer must be delayed until sepsis of the recipient site is inactive. Criteria used to for determining inactivity of the recipient site are negative bacterial cultures, absence of sinus tracts, negative C-reactive protein testing, sedimentation of less than 15mm/hr, for at least 1 month after the last episode of infection [59] . Infections also occur in patients that did not have an infection at the site of the defect. The incidence of postoperative deep infection after vascularized bone transfer alone in this patient group has been reported to be 10% [1] .