Open Access
CC BY 4.0 · Arch Plast Surg 2023; 50(05): 523-528
DOI: 10.1055/a-2119-3575
Extremity/Lymphedema
Case Report

Reconstruction of a Severe Open Tibiofibular Fracture using an Ipsilateral Vascularized Fractured Fibula with a Thoracodorsal Artery Perforator Free Flap

Lan Sook Chang 
1   Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, Korea
,
Dae Kwan Kim 
1   Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, Korea
,
Ji Ah Park 
2   Design Laboratory of the Technology Commercialization Center, Industry-University Cooperation Foundation of Hanyang University, Seoul, Korea
,
Kyu Tae Hwang 
3   Department of Orthopaedic Surgery, College of Medicine, Hanyang University, Seoul, Korea
,
Youn Hwan Kim 
1   Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, Korea
› Author Affiliations
Funding None.
› Further Information
  Permissions and Reprints
Preview

Abstract

The Gustilo IIIB tibiofibular fractures often result in long bone loss and extensive soft tissue defects. Reconstruction of these complex wounds is very challenging, especially when it includes long bone grafts, because the donor site is limited. We describe our experience using a set of chimeric ipsilateral vascularized fibula grafts with a thoracodorsal artery perforator free flap to reconstruct the traumatic tibia defects. A 66-year-old male suffered a severe comminuted tibia fracture and segmented fibula fracture with large soft tissue defects as a result of a traffic accident. He also had an open calcaneal fracture with soft tissue defects on the ipsilateral side. All the main vessels of the lower extremity were intact, and the cortical bone defect of the tibia was almost as large as the fractured fibula segment. We used an ipsilateral vascularized fibula graft to reconstruct the tibia and a thoracodorsal artery perforator flap to resurface the soft tissue, using the distal ends of peroneal vessels as named into sequential chimeric flaps. After 3 weeks, the calcaneal defect was reconstructed with second thoracodorsal artery perforator free flap. Reconstruction was successful and allowed rapid rehabilitation because of reduced donor site morbidity.

Keywords

perforator flap - free tissue flaps - fibula - tibia

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.


Authors' Contributions

Conceptualization: Y.H. Kim, K.T. Hwang. Data curation: L.S. Chang, D.K. Kim, J.A. Park. Formal analysis: D.K. Kim, J.A. Park. Writing - original draft: D.K. Kim. Writing - review and editing: L.S. Chang, Y.H. Kim, K.T. Hwang. All authors read and approved the final manuscript.


Ethical Approval

The study was performed in accordance with the principles of the Declaration of Helsinki. The study was approved for exemption by the Institutional Review Board of Hanyang University Hospital (IRB exemption No. 2022–12–044).


Patient Consent

Informed consent for publication of the study was obtained from the patient.




Publication History

Received: 02 January 2023

Accepted: 14 June 2023

Accepted Manuscript online:
28 June 2023

Article published online:
05 October 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA