Comparison of the clinical outcomes between the Modified Free Musculocutaneous Flap combined with Delayed Bone Reconstruction Technique and the Free Flap Combined with Masquelet Technique for post-traumatic osteomyelitis of the lower leg

Objective Post-traumatic osteomyelitis of the lower leg often presents with severe infectious bone and soft tissue defects, which require complex reconstruction techniques and carry a high risk of bone infection recurrence. This study proposes a modified free musculocutaneous flap combined with delayed bone reconstruction technique (MMDRT) and compares it with the free flap combined with Masquelet technique (FFCMT). Methods This retrospective cohort study included 45 patients with post-traumatic osteomyelitis of the lower leg who received MMDRT (22 cases) and FFCMT (23 cases) treatments at our hospital from January 2016 to August 2023. This study also analyzed the demographic data, underlying diseases, bone and soft tissue defects, surgical data, and postoperative follow-up results of the two groups. By comparing the bone healing score, healing time, infection control efficiency, and postoperative complications of the patients in the two groups, the efficacy differences of the two surgical methods were systematically evaluated. Results The healing time of the two groups was (13.06 ± 1.14) and (14.35 ± 1.01) months respectively ( P < 0.05). The time for white blood cell and C-reactive protein indicators to return to normal, and the incidence of fracture-related complications in the MMDRT group were both lower than those in the FFCMT group. Six months after bone grafting, the RUST score for tibial healing in the MMDRT group was higher than that in the FFCMT group, and the difference was statistically significant ( P < 0.05). However, there were no statistically significant differences in the number of debridement surgeries, operation time, intraoperative blood loss, incidence of flap complications, and the tibial healing RUST score and ankle AOFAS score at the last follow-up between the two groups ( P > 0.05). Conclusion The successful management of post-traumatic osteomyelitis hinges on effective infection control, coverage with well-vascularized tissue, and reconstruction of bone defects. While both MMDRT and FFCMT are effective for tibial osteomyelitis, MMDRT simplifies the bone grafting process, facilitating earlier infection control and shortening the fracture healing time.