Concomitant ipsilateral pedicled fibular transfer and free muscle flap forcompound tibial defect reconstruction

Three patients with compound injuries of the lower extremities were treated with pedicle fibular grafts and a free muscle flap concomitantly, There we re 1 female and 2 male patients, all of whom sustained high-energy trauma i n a motor vehicle accident. The bone defect of the tibia ranged from 8 to 1 2 cm, The size of the soft-tissue defect ranged from 24 x 15 cm to 28 x 15 cm. All patients underwent preoperative angiography to ensure the patency o f the peroneal artery and to avoid its use by risking viability of the leg. All patients were treated with an antegrade-flow pedicle fibular graft. Th e fibular graft was inserted as a single strut in 2 patients and as a doubl e-barrel strut in 1 patient. The pedicle of the free muscle flap was anasto mosed to the distal runoff of the fibular bone flap. All free muscle flap t ransfers succeeded without complication. Bone scans performed on postoperat ive day 7 showed viability of transferred bone. The average time to radiolo gical union was 9 months, and the average time to full weight bearing was 1 2 months. Screw loosening occurred in 2 patients and osteomyelitis was note d in another patient who was treated successfully with sequestrectomy and a ntibiotics. Indications for this technique are a large segmental bone defec t with a huge soft-tissue defect, and patency of the peroneal artery and at least one other major artery. This method provides the advantages of one-s tage reconstruction, avoidance of contralateral donor site morbidity, easy control of infection, and chance for early weight bearing. When selected ca refully, this technique can be considered when one wants to avoid a two-sta ge, two free flap transfer.