- •Extensive composite extremity defects after high-energy trauma represent a significant challenge for plastic surgeons.
- •An ideal technique would allow one-stage reconstruction while causing minimal donor site morbidity.
- •In 14 patients, we avoided amputation using a combination of a vascularized fibula bone flap and a perforator flap in a one-stage surgery with a good functional and aesthetic outcome.
Abstract
Background
Extensive composite extremity defects remain a challenge in plastic and reconstructive
surgery. To preserve the extremity, we used combined transfer composed of the vascularized
fibula flap and a perforator flap from various body parts to reconstruct extensive
composite extremity defects.
Patients and methods
From January 2004 to December 2018, 14 male patients aged 9 to 55 years with extensive
composite extremity defects (large soft-tissue and long bone defect) underwent reconstructive
surgery in our institution. The combined transfer surgery consisted of the vascularized
fibula bone flap and a perforator flap, such as anterolateral thigh flap, deep inferior
epigastric perforator flap, or thoracodorsal artery perforator flap.
Results
All fourteen patients were treated successfully using the combined transfer method.
The dimensions of the different perforator flaps ranged from 13 × 6 cm2 to 26 × 11 cm2, and the size of the skin paddle of the fibular osteocutaneous flap ranged from 9 × 3
cm2 to 21 × 7 cm2. The median length of the fibular graft was 15 cm. No serious donor site complications
were observed. Only one patient developed venous congestion and was salvaged. Another
patient had hematoma at the recipient site and underwent debridement. Though all patients
achieved bone union (median time of 8 months), two developed a stress fracture of
the transferred free fibula.
Conclusion
We were able to minimize donor site morbidity and avoid amputation in these patients
using the combined transfer technique Our results show that the combined transfer
of perforator flap and vascularized fibula flap with or without a skin paddle is a
feasible reconstruction option for the treatment of the extensive composite extremity
defects.
Keywords
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Article info
Publication history
Published online: February 09, 2022
Accepted:
February 8,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
