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Diamond et al. Plast Aesthet Res 2019;6:20 I http://dx.doi.org/10.20517/2347-9264.2019.26 Page 5 of 11

A B

C D

Figure 3. A case of Calcaneal Osteomyelitis treated with superthin anterolateral thigh (ALT) flap. A patient with Cierny-Mader class 3
osteomyelitis with calcaneal and proximal mid-foot erosions seen on (A) preoperative radiography. This required boney debridement
and soft tissue coverage with superthin ALT in single-stage; (B) shows postoperative radiography with clearance of osteomyelitis; (C)
demonstrating superthin (periscarpal) ALT; (D) after final inset and small skin graft for coverage of the vascular pedicle. This resulted in
full-ambulation in normal shoe gear

targeting the sciatic, tibial and peroneal nerves when appropriate. This achieved decreased rates of post-
[21]
operative narcotic use and shorter post-anesthesia unit stays . Additionally an early limb dependency
program helped patients dangle early in their post-operative course expediting hospital stay, discharge to
[22]
rehabilitation facilities, and return toward functional ambulation.

Outcome measures
Outcomes pertaining to flap specific morbidity such as partial flap loss, microvascular collapse, vessel
thrombosis, site infection and dehiscence were analyzed in addition to systemic complications.

With regard to osteomyelitis, discontinuation of antibiotic, achievement of boney union, return to weight
bearing, exchange of external for internal hardware and radiography were analyzed. Return to functional
ambulation, weight bearing and avoidance of amputation were compared across all groups.

Statistical analysis
Descriptive statistics were utilized to compare patient demographic information in regard to number,
frequency, mean and standard deviation. Student t-test for continuous data and Fischer’s exact test for
categorical data were used for univariate analysis to determine significant differences in wound and flap
characteristics along with donor site and flap complications between groups of patients. Those variables
achieving significance P-value < 0.05 were entered into a multivariable regression model to identify
independent risk factors associated with limb loss and osteomyelitis recurrence. Statistical significance
was defined as a P-value < 0.05. The analysis was performed using IBM SPSS software by members of our
research group within the institution (Version 3.154).

RESULTS
A total of 59 ALT flaps were performed from January 2015 to December 2017 for lower extremity salvage
reconstruction. The mean follow-up time of our population was 13.8 months (2.24-39.2 months). Flaps