No abstract

There are several options for the treatment of traumatic tibial defects. Among these options, free vascularized fibula and Ilizarov bone transport are well-known and effective techniques. The differences between both techniques and the indications for each of them are not well studied in the literature. Between September 1995 and December 2004, Ilizarov bone transport and free vascularized fibula were used to treat 25 traumatic bone. Patients were divided into two groups, Ilizarov group (12) and free fibula group (13). Preoperative data, operative data, duration of treatment, functional outcome, range of motion loss, number of secondary procedures, and type and rate of complications were compared in both groups. All the cases were ultimately united in both groups. Operative time and blood loss were significantly higher in the free fibula group. Although external fixation time was longer in the Ilizarov group, the overall duration of treatment was similar. Range of motion loss was less in the Ilizarov group, but the overall functional outcome was similar. There was no difference in complication rate, or number secondary procedures. Defect size was found to have the most significant effect on the results. Results were much better in the free fibula group when the defect length was 12 cm or more while the results were better in Ilizarov group when the defect length was less than 12 cm. We recommend using free vascularized fibula for traumatic tibial defects of 12 cm or more, whenever experience is available.

No abstract

In this article, we describe our technique and experience in harvesting the gracilis muscle for free functioning muscle transplantation (FFMT). The gracilis is the most commonly used muscle for FFMT. The main indication for gracilis FFMT is traumatic brachial plexus injury. Gracilis muscle has a class 2 vascular pedicle, with a dominant vascular pedicle originating from the profunda femoris vessels and a single motor nerve originating from the obturator nerve. During gracilis harvest, it is important to include the entire fascia around the muscle to ensure vascularity of the skin paddle and enhance muscle gliding in its new bed. Mobilization of the adductor longus allows tracing of the pedicle to its origin from the profunda femoris vessels, hence, achieving the maximum available length of the pedicle. Lengthening of gracilis tendon with a periosteal strip provides a free gracilis long enough to span the distance from the clavicle to the distal forearm. The main complications are related to the wound, and these include delayed healing, infection, and scar-related problems. The functional deficit after gracilis harvest is negligible.