Vascularized composite tissue transfers or open fractures with massive soft‐tissue defects in the lower extremities

From 1982 to 1998, we treated 39 patients with type IIIB and IIIC fractures in the lower extremities by vascularized composite tissue transfers. Thirty‐four of the lesions affected the lower leg, and 5 the foot and ankle. The peroneal flap was used in 25 cases, the latissimus dorsi musculocutaneous flap in 12, the scapula flap in 1, and the gracilis muscle flap in 1. In cases with a peroneal flap transfer, 18 cases used osteocutaneous flap with a fibula. Postoperative circulatory disturbances resulted in revision surgery in 9 patients. Eventually, grafting was successful in 37 patients. In patients with a lower leg reconstruction, additional bone grafting was performed in 7 of 16 patients with cutaneous or musculocutaneous flap transfers. No patient with osteocutaneous flap transfers required an additional bone grafting. The mean periods between injury and time to bone union were 11.7 months in patients with cutaneous flap transfers, and 7.5 months in patients with osteocutaneous flap transfers. © 2002 Wiley Liss, Inc. MICROSURGERY 22:114–119 2002

[1]  H. Yajima,et al.  Vascularized Bone Grafts to the Upper Extremities , 1998, Plastic and reconstructive surgery.

[2]  S. Kawai,et al.  One‐stage treatment of infected bone defects of the tibia with skin loss by free vascularized osteocutaneous grafts , 1995, Microsurgery.

[3]  H. Yajima,et al.  Vascularised fibular grafts for reconstruction of the femur. , 1993, The Journal of bone and joint surgery. British volume.

[4]  T. Husby,et al.  Free tissue transfer for type III tibial fractures. Microsurgery in 19 cases. , 1992, Acta orthopaedica Scandinavica.

[5]  H. Yajima,et al.  Vascularized fibula graft for reconstruction after resection of aggressive benign and malignant bone tumors , 1992 .

[6]  A. Minami,et al.  Vascularized iliac osteocutaneous flap based on the deep circumflex iliac vessels: Experience in 13 cases , 1989, Microsurgery.

[7]  P. Stern,et al.  Severe open fractures of the tibia. , 1987, The Journal of bone and joint surgery. American volume.

[8]  R. Mori,et al.  Reverse‐Flow Island Flap: Clinical Report and Venous Drainage , 1987, Plastic and reconstructive surgery.

[9]  S. Mathes,et al.  Management of Foot Injuries with Free‐Muscle Flaps , 1986, Plastic and reconstructive surgery.

[10]  K. Johansen,et al.  Open tibial fractures with associated vascular injuries: prognosis for limb salvage. , 1985, The Journal of trauma.

[11]  S. Imura,et al.  Peroneal Flap for Reconstruction in the Extremity: Preliminary Report , 1984, Plastic and reconstructive surgery.

[12]  D. N. Williams,et al.  Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. , 1984, The Journal of trauma.

[13]  A. Weiland,et al.  The efficacy of free tissue transfer in the treatment of osteomyelitis. , 1984, The Journal of bone and joint surgery. American volume.

[14]  A. Weiland,et al.  Soft tissue procedures for reconstruction of tibial shaft fractures. , 1983, Clinical orthopaedics and related research.

[15]  L. Teot,et al.  The Free Scapular Flap , 1982, Plastic and reconstructive surgery.

[16]  B. Pontén.  The fasciocutaneous flap: its use in soft tissue defects of the lower leg. , 1981, British journal of plastic surgery.

[17]  P. Manson,et al.  Experience with Thirteen Latissimus Dorsi Myocutaneous Free Flaps , 1979, Plastic and reconstructive surgery.

[18]  G. I. Taylor,et al.  THE FREE VASCULARIZED BONE GRAFT: A Clinical Extension of Microvascular Techniques , 1975, Plastic and reconstructive surgery.