Use of an islanded fasciocutaneous flap in the lower limb following distraction callotasis

Severe limb injuries present a challenge to the attending surgeon and there has been an emergence of complex modes of treatment. The Ilizarov techniqu e for distraction osteogenesis is accepted as a worthwhile option in select ed cases of massive segmental bone loss. The blood supply of the bone durin g this process has been studied experimentally but the response of the soft tissue envelope to the process of compression followed by slow and progres sive elongation is not entirely understood. We present a case of lower limb trauma where a combined approach to reconstruction was required with acute shortening followed by distraction osteogenesis for a major segmental tibi al defect. Late soft tissue reconstruction for persistent ulceration over t he tibia was then undertaken using a distally based fasciocutaneous flap. ( C) 2000 The British Association of Plastic Surgeons.