[An unsual case of an extensive heat necrosis].

We report on an unusual case of an extensive heat necrosis of the tibia and its surrounding tissues including the skin after closed IM nailing. The first clinical sign appeared shortly after the procedure as circular skin necrosis over the tibial crest. The severe necrosis of a bone segment, the surrounding soft parts as well as the skin was probably the sequella of reaming of a pathologically altered bone with the tourniquet inflated. Only after a free latissimus dorsi transfer and the resection of the dead bone that was then bridged by a segmental bone transport according to the Ilizarov technique the situation could be salvaged. We concluded that reaming with the tourniquet inflated should never be done, as it can cause severe damage due to abnormal heat generation.