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

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.

Masquelet Technique Combined with Tissue Flap Transplantation in The Treatment of Infectious Complex Tissue Defect: A Clinical Analysis

Background: Infectious complex tissue defects have been described as injuries with composite infectious bone defects and extensive soft tissue damage, which are still austere challenges for orthopedists all around the world. The study retrospectively evaluated the Masquelet technique combined with the tissue flap transplantation for the treatment of infectious complex tissue defects and assess key factors of success in this technique.Methods: From December 2016 to December 2019, 22 patients of infectious complex tissue defects were recruited for the study. All the cases experienced a two-stages treatment. Thorough debridement, stabilization of fracture by external fixation and implantation of a cement spacer mixed with antibiotics in the first stage. Simultaneously, suitable tissue flaps were designed and transplanted for the soft tissue defect. 6-8 weeks later, after the elimination of the infection, the cement spacer was removed carefully from the induced membrane and cancellous bone was grafted into the site of bone defect. The average duration of follow-up was 21 months.Results: Infection was eliminated after the first stage intervention without recurrence. All the transplanted tissue flaps were survived. Bone union was achieved in all patients in a period of 16-31 weeks following the second stage surgery. According to the Paley fracture healing score, 17 patients showed excellent results and 5 patients displayed good results regarding bone outcomes. When considering functional outcomes, 14 patients exhibited excellent results and 8 patients displayed good results.Conclusions: This study showed evidences that Masquelet technique combined with tissue flap transplantation was an effective method to repair the infectious complex tissue defects. We also demonstrate that a complete soft-tissue envelope plays an important role in the formation of the induced membrane which promote bone union and in the anti-infection treatment.

Repair of Soft Tissue Defect with Intraoperative Tissue Expansion after Surgical Resection of Dermatofibrosarcoma Protuberans: A Case Report

While it is the most frequently observed subtype of all cutaneous soft tissue sarcomas, dermatofibrosarcoma protuberans is still uncommon, with a high local recurrence rate. Although surgical resection could be a simple curative procedure, surgeons can encounter difficulties when dissecting or closing the wound, depending on the location and the size of the tumor. We present a case report of direct repair of soft tissue defect with intraoperative tissue expansion after sarcoma resection. A 62-year-old male visited our clinic with an approximately 1.5×1.5 cm-sized mass on his lower leg. We excised the mass, which a pathologic study confirmed as dermatofibrosarcoma protuberans. The authors planned a wide excision of the lesion as soon as possible. The excised lesion was not large; however, the soft tissue defect could not be closed by direct approximation. We eventually closed the tumor resection wound using a Foley catheter as a tissue expander. The patient’s wound healed well, albeit leaving a minimal scar. This case suggests that a Foley catheter could be an effective and versatile tool that is readily available in any medical setting, including after a small tumor resection in outpatient surgery.