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The Combined Use of a Neurocutaneous Flap and the Ilizarov Technique for Reconstruction of Large Soft Tissue Defects and Bone Loss in the Tibia

Xu, Jia MD; Zhong, Wan-Run MD, PhD; Cheng, Liang MD; Wang, Chun-Yang MD, PhD; Wen, Gen MD; Han, Pei MD, PhD; Chai, Yi-Min MD, PhD

doi: 10.1097/SAP.0000000000000921
Reconstructive Surgery

Background Management of posttraumatic large soft tissue defects and bone loss remains a therapeutic and surgical challenge for orthopedic surgeons. We assessed the use of a neurocutaneous flap and the Ilizarov technique in the reconstruction of severe composite defects in the tibia.

Methods We retrospectively reviewed 18 consecutive patients with trauma-related soft tissue defects and bone loss. The size of the soft tissue defect ranges from 8 × 9 cm to 14 × 18 cm. The mean size of bone loss was 4.5 cm. A great saphenous neurocutaneous flap or sural neurocutaneous flap was created to reconstruct the soft tissue defect. The Ilizarov external fixator was applied to reconstruct bony loss by means of distraction osteogenesis.

Results The mean follow-up period was 38.8 months. All transferred flaps survived completely. The area covered ranged from 9 × 10 cm to 15 × 20 cm. The mean distraction length and duration of use of the external fixator were 6 cm and 11.4 months, respectively. All patients achieved final union. Complications of superficial pin-tract infections and mild Achilles tendon contracture were observed, but these were resolved over time. All patients were satisfied with the outcome of the surgery.

Conclusions A well-vascularized neurocutaneous flap is a safe and effective option in lower extremity reconstruction under a stable mechanical environment, which can be created using the Ilizarov technique. It is a good option for reconstructing severe complex defects in the lower limb.

From the Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.

Received March 5, 2016, and accepted for publication, after revision August 22, 2016.

Y.-M.C. has received grants from the National Natural Science Foundation of China (NSFC 81572122) and the Shanghai Committee of Science and Technology Research Projects (11JC1409400). For the remaining authors, no conflicts were declared.

J.X. and W.-R.Z. contributed equally to this work.

Ethical review committee statement: This study has been approved by research ethics committee of Shanghai Jiao Tong University Affiliated Sixth People's Hospital.

Reprints: Yi-Min Chai, MD, PhD. Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Yishan Rd 600, Shanghai 200233, PR China. E-mail:

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