COMBINED MUSCLE FLAP AND ILIZAROV RECONSTRUCTION FOR BONE AND SOFT-TISSUE DEFECTS

Thirty-six patients were treated by Ilizarov transport in conjunction with muscle and myocutaneous flaps coverage. Thirty-one free flaps and 5 rotation flaps were performed. In 13 patients the procedures were c arried out in 1-stage or simultaneous manner. In 23 patients, soft tis sue coverage proceeded as the initial step followed by Ilizarov recons truction as a delayed procedure. All flaps survived the simultaneous a nd delayed procedures and there were no anastomotic complications, but partial flap necrosis occurred in 1 patient 3 months after the index procedure at the time of flap elevation for docking site bone graft pl acement. The mean segmental defects were 10 cm and 5.8 cm for the simu ltaneous and delayed groups, respectively. The followup interval from the time of free flap coverage ranged from 2 to 44 months in the simul taneous group with a mean and median of 22 and 24 months, respectively . Twelve patients completed treatment in the simultaneous group with t he followup interval from frame removal ranging from 3 to 36 months wi th a mean and median of 18 and 14 months, respectively. In the delayed group this interval ranged from 1 to 36 months, with a mean and media n of 16 and 12 months, respectively, and a mean and median of 24.5 and 21 months, respectively, from the time of the index procedure. Union and absence of infection were achieved in 35 of 36 patients presenting with an acute open fracture, infected nonunion, or aseptic nonunion w ithout stable soft tissue coverage, The Ilizarov fixators remained in place for a median of 9.5 months for the simultaneous group and 8.5 mo nths for the delayed group. When soft tissue defects accompany an infe cted nonunion or high grade open fracture, the traditional Ilizarov tr eatment approach of soft tissue recruitment into the wound from the di stant corticotomy site is inconsistent with the proven benefit of earl y soft tissue coverage. The combined approach provides a more reliable soft tissue bed for early cancellous bone grafting of the docking sit e and permits the accurate restoration of limb length for these very d ifficult problems.