scholarly journals Long-term follow-up of a severely traumatized leg treated with ipsilateral fracture-united fibular transfer in a patient with amputation of the contralateral leg: a case report

2021 ◽  
Vol 48 (6) ◽  
pp. 699-702
Author(s):  
Eon Su Kim ◽  
Chae Eun Yang ◽  
Jiye Kim ◽  
Sug Won Kim
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Weight Bearing ◽  
Skin Flap ◽  
Soft Tissue Defect ◽  
Tissue Defect ◽  
Tibial Defect ◽  
Segmental Fracture ◽  
Lower Extremity Reconstruction ◽  
The Right

Extensive bone loss associated with severe vascular injury remains a challenge for lower extremity reconstruction. The fibular free flap has been utilized for many decades to reconstruct long-segment tibial defects. We present an unusual scenario of unilateral weight-bearing, wherein we salvaged the sole lower extremity by transfer of the fractured ipsilateral fibula and a bipedicled skin flap. A 38-year-old man sustained a severe crush injury in the right leg with loss of circulation. His left lower leg had a soft tissue defect measuring 20×15 cm with an exposed comminuted fracture and a 17-cm tibial defect, along with a segmental fracture of the fibula. Subsequently, we reconstructed the tibial defect by transferring a 17-cm-long section of the ipsilateral fibula. We covered the soft tissue defect with a bipedicled skin flap. The patient eventually began to ambulate independently after surgery.

An Effective Technique for Managing the Calcaneus Osteomyelitis Combined with Soft-Tissue Defect

2021 ◽  
pp. 153473462110166
Author(s):  
Ping Peng ◽  
Zhong-Gen Dong ◽  
Lihong Liu ◽  
Jian-Wei Wei ◽  
Zhaobiao Luo ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Weight Bearing ◽  
Soft Tissue Defect ◽  
Effective Technique ◽  
Sural Flap ◽  
Tissue Defect ◽  
Type Iii ◽  
Distally Based ◽  
Distally Based Sural Flap

The treatment of the Cierny–Mader (C–M) type III–IV calcaneus osteomyelitis combining with the soft-tissue defect is sophisticated and difficult. The aim of this study is to introduce the application and availability of the modified distally based sural flap with an adipofascial extension to reconstruct these defects. We retrospectively reviewed the data of 37 patients with C–M type III–IV calcaneus osteomyelitis accompanied with soft-tissue defect between December 2004 and December 2019. A modified distally based sural flap with an adipofascial extension was conducted to reconstruct the defect. The patient's demographics, duration of the diseases, etiology, reconstruction outcomes, infection control rate, recurrence rate, amputation rate, and follow-up data were collected to evaluate the effectiveness and reliability of the modification. The American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot scale was applied to assess the function of the ankle and hindfoot. Thirty-four flaps survived uneventfully, 1 flap displayed marginal necrosis and 2 flaps (5.41%) developed partial necrosis. Using this modified flap alone or combining with some simple salvage methods reconstructed all of the defects successfully. The calcaneus osteomyelitis was cured successfully, and no recurrences were observed during the follow-up period. The AOFAS ankle and hindfoot scores were excellent in 27 patients and good in 8 patients. The distally based sural flap with an adipofacial extension is a simple and effective technique to reconstruct the calcaneus osteomyelitis combined with soft-tissue defect in 1 stage. Applications of the adipofacial extension to obliterate the dead space and the well-vascularized skin island to cover the defect are the guarantee of achieving good ankle and foot functions. However, this technique is not appropriate for the patients with calcaneum less than half weight-bearing area.

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