Citation

Karami RA, Ghieh FM, Chalhoub RS, Saghieh SS, Lakkis SA, Ibrahim AE. Int. Orthop. 2019; ePub(ePub): ePub.

Affiliation

Department of Surgery, Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Cairo Street, Beirut, Lebanon. amir.ibrahim78@gmail.com.

Copyright

(Copyright © 2019, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1007/s00264-019-04423-w

PMID

31628516

Abstract

BACKGROUND: In a high conflict region, war injuries to the distal lower extremity are a major source of large composite defects involving bone and soft tissues. These defects are at the edge between using a single free flap [osteo-(+/-myo) cutaneous] vs double free flap reconstruction (bone and soft tissue). In this paper, we present our experience and outcomes in treating patients with leg war injury reconstructed using a single free fibula flap.

METHODS: Fifteen patients with distal leg composite defects secondary to war injuries were treated between January 2015 and March 2016. All patients were reconstructed using single barrel free fibula osteo-(+/-myo)cutaneous flap where single or double skin paddles were used according to the soft tissue defect requiring coverage.

RESULTS: There were no cases of total or partial flap loss. Complications were limited to three cases including traumatic fibula fracture, venous congestion with negative findings, and residual soft tissue defect requiring coverage. There were no cases of wound dehiscence or infection. Mean follow-up time was 418.8 days. Mean bone healing time was nine months after which patients were allowed full weight bearing.

CONCLUSION: A single barrel free fibula osteo-(+/-myo)cutaneous flap is a valid and reliable tool for reconstruction composite lower extremity defects post-war injury. Adequate planning of fibula flap soft tissue components (skin, muscle) rearrangement is essential for success in such challenging reconstructions.

Language: en

Keywords

Free fibula flap; Lower extremity reconstruction; Microsurgery; Reconstructive surgery; War injury