ABSTRACT
In this study microvascular free tissue transfers have been performed for soft tissue and bone reconstruction of the leg in 22 patients with chronic traumatic bone wounds. The mean period of chronic bone exposure and drainage was 3.5 months, with a range of 2 months to 1 year. The mean age was 23.4 years, and included 20 male and 2 female patients. The criteria for the diagnosis of chronic bone wounds applied for patient selection in this study included: Chronic open draining bony wounds for more than 6 weeks, a positive culture from the wound at the time of debridement, and X-ray findings consistent with chronic bone infections. Patients were classified into 4 types according to the zone of injury. In type 1 a free latissimus dorsi muscle was used for soft tissue reconstruction, in type 2 a free latissimus and-fixation of the tibia with a plate or external fixator, in type 3 a free latissimus flap and an external fixator for bone transport and in type 4 an osteocutaneous free vascularized fibula was used to reconstruct both soft tissue and bone. Patients were followed up for an average of 24 months. In all patients the flaps survived and there was control of the infection and union of bone. All patients were able to weight bear and return to their original work. From the results of this study we concluded that our policy of extensive debridment followed by reconstruction of both bone and soft tissue by microvascular surgical techniques proved to be effective and reliable.