Use of the Ilizarov technique after a free microvascular muscle flap transplantation in massive trauma of the lower leg.

The use of microvascular flaps has become routine in treating compound tibial fractures with extensive soft-tissue loss. Vascularized bone grafts, or shortening of the leg and later elongation with the Ilizarov technique, have been advocated if the injury involves major bone loss. The authors treated four of these massive injuries by debridement and external fixation with the leg at its normal length. Acute free flap reconstructions (four latissimus dorsi, and one case added with a vascularized iliac crest graft) were performed. Tibial corticotomy was later made above or below the defect (varying from 2.5 to 7 cm) and the bone was corrected with slow (0.5-0.75 mm/day) segmental distraction. This was combined with elongation of the leg in two cases. The consolidation time after corticotomy ranged from nine to 12 weeks. The healing time of the fracture after the initial injury was 12, 14, 22, and 36 months, respectively. In massive injury of the lower leg, maintain the initial length of the leg, and perform early free muscle flap reconstruction and segmental bone distraction under the free flap.