Combined free flap, Ilizarov lengthening and prosthetic fitting in the reconstruction of a proximal forearm amputation--a case report.

A composite free latissimus dorsi musculocutaneous flap combined with Ilizarov lengthening was used in the resurfacing of the elbow and the reconstruction of the forearm following a very proximal below elbow amputation with soft tissue degloving to the level of the mid arm. The free flap provided gliding soft tissue to the elbow joint, and the deep fascia and muscle components of the flap were contoured round the bony stump so as to allow bone transport within the soft tissue envelope. The lengthening achieved was 14 cm with no bone resorption at the end of the stump. The reconstructed forearm, with a well-contoured stump covered with durable and adherent soft tissue, allowed the fitting of a forearm-based lightweight hand glove prosthesis. With the combined modalities of microsurgical free tissue transfer, the Ilizarov method of slow distraction and prosthetic fitting, we were able to achieve restoration of both form and function in a difficult case of major upper extremity amputation.