Combining the External Fixation and Microsurgical Osteoseptocutaneous Flap Transplantation Methods for Limb Salvage

BACKGROUND The correction of large area limb defects that are the result of congenital abnormalities, traumatic injury, inflammation, or tumors is a challenging task for clinicians. The need to restore the physical, mechanical, and cosmetic aspects of the limb results in a difficult balancing act between deformity repair and tissue reconstruction, between the soft tissue and bone reconstructions, and between the physical, mechanical, and esthetic restorations. METHODS Between 2003 and 2011, 59 patients with large area limb defects underwent 1- or 2-stage reconstructions that combined external fixation with microsurgical osteocutaneous flap transfer. In 1-stage reconstruction, the Ilizarov device was applied as a dynamic fixator before pathological bone resection. Free osteoseptocutaneous flap transplantation was then performed. This is suitable for simple bone defects with temporary continuity such as osteomyelitis. In 2-stage reconstruction, the Ilizarov device served as both an external fixator and tractor before debridement. This was followed by secondary free osteoseptocutaneous flap transplantation. This is suitable for complex bone defects like those seen in pseudarthrosis, fractures, and tumors. In all cases, the Ilizarov device was kept in position until bone union was confirmed by both surgeons and the radiologist. RESULTS All patients survived the procedure. Using Paley's classification system, there were 3 (5.1%) true complications, 2 (3.4%) obstacles, and 5 (8.5%) problems. CONCLUSIONS The staged methods allowed the seamless repair and reconstruction of bone and combined it with soft tissue reconstruction. This simultaneously restored the limb function and esthetics with minimal costs in terms of time, money, and patient pain.