Reconstruction of bone loss of diaphyseal tibial bone using circular external fixator

Aim was to achieve filling of large diaphyseal defect and simultaneous weight bearing of injured extremity till union was achieved. A metaphyseal corticotomy and gradual distraction of bone segment was performed. We used ilzarove frame on all the cases. Good alignment and stable fixation of bone fragments were achieved. A bone fragment of adequate length [4-10 cm] was created after corticotomy, which was done in proximal or distal tibial metaphyseal area. 7-10 days after corticotomy, fragments were traveled axially across the defect. The transportation was achieved by the use of olive wires and central transporting ring. Regeneration of distraction gap was achieved in all 16 patients. Union at the docking site was achieved in 15 patients and union was not related to length of bone defect. In one patient there was failure of the union at docking site. This was due to incomplete removal of ebernated and atrophic bone ends which was addressed by excision of bone ends and bone grafting. Healing of infection occurred in all patients without second operation. Residual varus deformity remained in two patients with 10 degree and 12 degree respectively. The Ilizarove technique for treatment of segment defects of diaphyseal long bones are effective and offer many advantages. One of the greater advantages of technique is that it allows simultaneous treatment of bone loss, infection, nonunion, deformity and allows weight bearing

Wide base reverse sural flap for reconstruction of soft tissue defects of distal leg, ankle and heel

The management of soft tissue defects over distal leg, ankle and heel is technically demanding procedure. Skin grafts are not suitable and donor sites for local flaps are limited: free tissue transfer needs special equipments and microsurgical team. Aim was to achieve durable coverage in simplest way, to save leg and restore function leg, ankle foot unit. This prospective study was conducted at Department of Orthopaedic Surgery, Nishtar Hospital, Multan from June 2002 to June 2005. Eleven patients with soft tissue defects of distal leg, ankle and heel which required flap coverage were included. Preoperative data was recorded and photographs taken. Modified wide base cutaneous pedicale reverse flow superficial sural artery flap was used in all patients. Skin pedicle was not tubed. Flap dimensions harvested were recorded and photograph taken. Out of eleven patients, 10 were male, one female, age ranged from 15-49 years. Eight patients had defect due to trauma, two osteomyelitis and one patient was with ischemic heel sore with exposed achillis tendon. Maximum flaps dimensions were 12.5 x 10.5 cm. postoperatively nine flaps survived completely. Two had marginal tip necrosis. Flap oedema and venous congestion occurred in 1. One patient had wound dehiscence. There were no deep infections. Three patients had non-union distal tibia, which needed another procedure. During our follow up all wounds remain stable. Wide base reverse flow superficial sural artery flap was a viable single stage reconstructive option for our patients with distal leg, ankle and heel soft tissue defects. Procedure is simple and results are satisfactory