Ipsilateral Vascularized Fibular or Osteocutaneous Fibular Flaps in Traumatic Lower Extremity Reconstruction

Abstract

Background: Tibial and distal femur bone deficit complicated with infection, non- union, and soft tissue deficit was successfully repaired with ipsilateral vascular vascularized osteo and osteocutaneous flaps.

Methods: Fractures with acute wound infection were treated with serial irrigation, debridement, betadiene packing, or antibiotic bead chains, followed by immediate flap coverage. Fractures with chronic infection were treated with the same protocol as acute infections, but the infected segment was aggressively resected, 2 or 3 screws were used to stabilize the grafted fibula to recipient sites both proximally and distally, then an external fixator was used to protect the fixation. Atrophic non-unions were treated by resection and primary vascularized fibular or osteocutaneous fibular flaps.

Results: Wound healing and bone union were achieved in all 4 cases. The duration of external fixation ranged from 2 to 4 months. No postoperative infection was noticed in our patients. In one case, a stress fracture occurred at 7 months and was successfully managed in a PTB brace. With aggressive postoperative physical therapy, knee range of motion was restored to an average of 95 degrees.

Conclusion: We have found that ipsilateral fibular and osteocutaneous fibular flaps are a reasonable option for the treatment of traumatic bone deficit with or without infection, and results in rapid and predictable recovery from atrophic non-union.

Key words

Tibia - femur - infected non-union - traumatic osteomyelitis - antibiotic beads - tissue deficit - fibular graft - one-stage

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