The Combined Use of a Neurocutaneous Flap and the Ilizarov Technique for Reconstruction of Large Soft Tissue Defects and Bone Loss in the Tibia.

BACKGROUND: Management of posttraumatic large soft tissue defects and bone loss remains a therapeutic and surgical challenge for orthopedic surgeons. We assessed the use of a neurocutaneous flap and the Ilizarov technique in the reconstruction of severe composite defects in the tibia. METHODS: We retrospectively reviewed 18 consecutive patients with trauma-related soft tissue defects and bone loss. The size of the soft tissue defect ranges from 8 × 9 cm to 14 × 18 cm. The mean size of bone loss was 4.5 cm. A great saphenous neurocutaneous flap or sural neurocutaneous flap was created to reconstruct the soft tissue defect. The Ilizarov external fixator was applied to reconstruct bony loss by means of distraction osteogenesis. RESULTS: The mean follow-up period was 38.8 months. All transferred flaps survived completely. The area covered ranged from 9 × 10 cm to 15 × 20 cm. The mean distraction length and duration of use of the external fixator were 6 cm and 11.4 months, respectively. All patients achieved final union. Complications of superficial pin-tract infections and mild Achilles tendon contracture were observed, but these were resolved over time. All patients were satisfied with the outcome of the surgery. CONCLUSIONS: A well-vascularized neurocutaneous flap is a safe and effective option in lower extremity reconstruction under a stable mechanical environment, which can be created using the Ilizarov technique. It is a good option for reconstructing severe complex defects in the lower limb.

Pedicled fibular flap for reconstruction of composite defects in foot.

INTRODUCTION: Reconstruction of complex injuries involving bone and soft-tissue in foot remains a tough challenge for surgeons. The free fibular flap is a popular flap for treating these composite defects. However, complications caused by microvascular anastomoses are not uncommon. Herein, we designed a pedicled fibular flap elevated in the ipsilateral leg for reconstruction of multiple defects in foot. METHODS: From July 2005 to April 2013, four patients with composite defects in foot were treated by pedicled fibular flaps. The defects were located in the first metatarsal bone and medial cuneiform bone in two patients, in the fourth metatarsal bone in one patient, and in the second to fourth metatarsal bones in one patient. The size of soft-tissue defects ranged from 10×7 cm to 15×7 cm, and the length of bone defects ranged from 6 to 8 cm. RESULTS: The length of fibular grafts ranged from 7 to 8.5 cm, and the size of skin flaps ranged from 11×8 cm to 16×8 cm. All flaps survived completely. Complications occurred in two patients. One suffered moderate venous congestion and the flap survived without intervention. The other one sustained re-infection. Debridement was performed and the wound healed uneventfully. Follow-up ranged from 8 to 32 months. Bone union occurred at an average of 12 weeks, and the skin flaps showed good cosmetic results. No serous donor-site complications occurred. CONCLUSION: The pedicled fibular flap transfer could avoid anastomosis complications and preserve healthy limb. It is a good option for reconstruction of complex defects in foot.