Bone Gutter and Myoosseous Muscle Flap in Chronic Femoral Osteomyelitis in Adults: A 2-Year Prospective Case Series

Background: Chronic osteomyelitis of the femur is a complex orthopedic challenge that needs comprehensive surgical and antibiotic treatment. Bone guttering with myoosseous muscle flap coverage offers promising outcomes in controlling infection and enhancing tissue healing. Objective: To assess the effectiveness of bone gutter and myoosseous muscle flap in adult males with chronic femur osteomyelitis. Methods: A prospective case series study enrolled 24 male patients with chronic femoral shaft osteomyelitis. (62.5%) Cases were managed by bone guttering, myoosseous muscle flap, or implant removal followed by the same procedure (37.5%). Antibiotics were given based on culture and sensitivity, and the Cierny-Mader classification was used for staging. The clinical outcome was assessed by infection resolution, wound healing, and recurrence rates over 24 months of follow-up. Results: The mean age was 29.00±6.56 years. All cases presented with discharging sinus, Staphylococcus aureus (50.0%), and Streptococcus (25.0%), which were the most frequently reported microorganisms. 50.0% of cases were treated with fusidic acid, followed by Augmentin (25%) for 6 weeks. After 2 years of follow-up, complete infection resolution and healing were achieved (100.0%). Conclusions: Bone guttering with myoosseous muscle flap is a simple, reproducible, and highly effective management strategy for chronic femoral osteomyelitis. The approach achieved complete bone infection control when combined with targeted antibiotics. Larger multicentric studies are recommended to generalize these findings.