The role of perforating artery pedicled neurotrophic flap in the treatment of compound tissue defect of tibia with Ilizarov technique.
Abstract Background The aim of this research is to present our experience with the combined use of pedicled neurotrophic flap and distraction osteogenesis in management of complex lower extremity injuries with composite bone and soft tissue defects and assess the functional and cosmetic results of this method. Methods Between 2008 and 2016, soft tissue coverage with pedicled neurotrophic flap followed by distraction osteogenesis using Ilizarov external fixator was performed in 25 patients for reconstruction of segmental bone defects of lower extremity complicated by massive loss of soft tissue. There were 16 men and 9 women: their mean age was 39 years (23 to 57)at the time of surgery. The soft tissue defect after radical debridement ranged from 5 × 9 cm2 to 11 × 14 cm2, and the average size of segmental defect was 5.02 (2.5 to 7.5) cm. Results The distally based sural neurovascular flap was performed in 13 patients, and the greater saphenous neurocutaneous perforator flap in 12 patients. All flaps survived completely without complications. The bone defects were corrected by a mean lengthening of 6.74 (4.5 to 9.5) cm. The function was judged to be excellent in 12 patients and good in 13 patients. Bone results were graded as excellent in 18 patients and good in 7 patients. Complications observed in the process of the treatment included pain, pin tract infections (PTI), ankle midfoot joints stiffness, and nonunion of docking sites. All the cases achieved successful limb salvage and satisfactory function recovery without recurrence of infection. Conclusions The combined technique of a perforator artery pedicled neurotrophic flap and distraction osteogenesis should be considered to be an effective alternative approach in the salvage treatment of the massively traumatized and chronically infected lower extremity.