FIG. 16-52. Six months later, with no evidence of bone infection or regeneration, vascularized fibula was planned.

FIG. 16-53. The left fibula has been elevated on its peroneal vessels. A distal skin paddle has been included, preserving the inconsistent intermuscular perforators to the skin.

FIG. 16-54. The fibular segment has been reversed in anatomic orientation. The bone is fixed to the proximal and distal tibia (arrow), and the skin paddle is now proximal.

FIG. 16-55. Inclusion of the skin paddle facilitates vascular monitoring.

FIG. 16-56. Follow-up x ray at 8 months shows good bone healing, hypertrophy of the graft, and no infection.

FIG. 16-57. Leg healed, length normal. The child is walking with a protective orthosis.

CASE 7

A 19-year-old man sustained an accidental self-inflicted shotgun wound to his left leg, resulting in a comminuted Grade III-C tibial-fibular fracture.

FIG. 16-58. An external fixator was applied at the initial exploration.

FIG. 16-59. After serial debridements, the wound was closed with a myocutaneous latissimus dorsi microvascular transplant. Muscle and small skin island for monitoring, ready for transplantation.

FIG. 16-60.Transplant next to debrided wound.

FIG. 16-61. Closed wound at 3 months. The external fixator was replaced to place the pins outside the surgical wound.

FIG. 16-62. An osteocutaneous fibula ready for transplantation to the bony defect

FIG. 16-63. Transplant in place.

FIG. 16-64. X ray of graft at 6 months.

FIG. 16-65. Normal length of leg. Patient is shown walking at 6 months.

References

1. Berger, A.: Microvascular transplantation of osteocutaneous flaps (combined free tissue transfer). Chirurgia 56(12): 761-7, 1985.

2. Bosse, J.P.: The free vascularized scapular bone graft. Presented at G.A.M., Windsor, Canada, 1982.

next page...