Combined free anterolateral thigh flap and tibial bone transport for resurfacing large segmental bone and soft tissue defect of lower extremities

Objective To investigate the clinical efficacy of free anterolateral thigh flap transport combined with tibia bone transport in reconstruction of large segmental bone and soft tissue defect of lower extremities. Methods This retrospective case series review included 27 patients sustaining large segmental bone and soft tissue defect of lower extremities admitted between August 2006 and April 2016. There were 22 males and 5 females, with a mean age of 36 years (range, 16-56 years). Eleven patients were identified with Gustilo ⅢB type open injury, 14 Gustilo ⅢC type open injury, and 2 large bone and soft tissue defects after internal fixation of the closed lower extremity fractures. Size of soft tissue defect was 10.0 cm×5.5 cm-21.0 cm×10.0 cm. Size of the flaps was 13.0 cm×7.5 cm-23.0 cm×11.0 cm. Length of bone defect was 5.5~18 cm and length of bone transport was 6~21 cm. Anterolateral thigh flaps were employed for limb salvage. After wound healing, bone transport with the use of an Ilizarov ring external fixator was done to treat tibial bone defect. Flap survival, wound healing time, bone transport time, bone healing index and time of external fixator removal were recorded. Mineralization of regenerate bone was assessed using the bone healing index. Results were evaluated using the Paley scoring system. Results Mean follow-up period was 4 years (range, 1-8 years). All flaps survived and the wounds were healed without ulceration or infection. Mean time for wound healing was 4.5 months (range, 1-18 months). Time interval between wound healing and bone transport was 1-4 days (mean, 1.5 months). Mean bone healing index was 55 days (range, 45-65 days), demonstrating good bone mineralization. Mean time of external fixator removal was 24.5 months (range, 10-39 months). Shape of the tibia was satisfied. All patients were able to ambulate without use of an aid. According to the Paley scoring system, results were excellent in 21 patients and good in 6 patients. Conclusion Combined free anterolateral thigh flap and tibial bone transport provides enough bone and soft tissue and satisfactory recovery of limb function and morphology, indicating an effective treatment for large segmental bone and soft tissue defect of lower extremities. Key words: Surgical flaps; Ilizarov technique; Tibial fractures; Soft tissue injuries; Bone defect