Reconstruction of the Lower Extremity Using Free Flaps
A 39-year-old man had undergone external fixation at another hospital for the management of an open comminuted fracture of the right tibia received in a traffic accident. Then, in the department of orthopedic surgery at our medical institution, the patient also underwent iliac bone grafting at the site of a bone defect caused by the comminuted fracture. However, he bone graft necrotized and progressed to osteomyelitis. Therefore, the patient was referred to us for reconstruction. At the time of referral, the patient had a 8 cm × 12 cm soft tissue defect, accompanied by a bone defect approximately 8 cm in size. We performed debridement, including the dead bone tissue with osteomyelitis to prepare the recipient sites. We elevated an osteocutaneous free flap from the left side, involving 12 cm of fibula, and then inset it to the recipient site. Following the fixation of the proximal and distal part of the tibia using a screw, we performed external fixation. The artery was anastomosed end-to-side to the anterior tibial artery. In addition, 2 venae comitantes were anastomosed end-to-end to the lesser saphenous vein and the vena comitante of the anterior tibial artery. A split-thickness skin graft was performed at the donor sites ().