Management of soft-tissue problems in leg trauma in conjunction with application of the Ilizarov fixator assembly

Forty-five patients presenting with high-energy open grade III tibial diaph yseal fractures were treated with the Ilizarov technique. Of these patients , 28 required plastic surgical intervention for achieving wound closure. Mo st of the injuries were complicated by initial neglect and inadequate prima ry soft-tissue coverage resulting in osteitis, sequestration, and segmental diaphyseal tibial defects, often in combination with skin-envelope deficit s of various types in and around the fracture perimeter. The unique soft-ti ssue problems encounter ed while using the Ilizarov fixator have not been f ocused on in previous reports on the management of segmental bone defects. Four basic local flap procedures: the transposition flap, rotation flap, ad ipofascial turnover flap, and Z-plasty are useful and versatile for managin g most types and grades of soft-tissue defects associated with a segmental bone loss with the Ilizarov technique.