Complications in the Treatment of Delayed Union and Underlying Chronic Osteomyelitis After Right Crural Fracture Treated With Anterolateral Thigh Flap and Double-Barrelled Vascularized Fibula Graft

Abstract

Background: Segmental bone defects pose a major, unsolved clinical challenge and may be the result of high-energy trauma, infection, and tumour resection or revision surgery. Several options exist to reconstruct, including Ilizarov bone transport, Masquelet technique, cylindrical mesh technique, allografts, and vascularized bone autografts. We present a patient with a delayed union of the tibia with concomitant chronic osteomyelitis treated with anterolateral thigh (ALT) flap and double-barrelled vascularized fibula graft.Case presentation: A 60-year-old male with a chronic pretibial wound with underlying osteomyelitis of the right leg presented himself at the emergency department and was admitted to the surgical ward. He had complex chronic osteomyelitis of a tibial non-union after an earlier right crural fracture (a previous work-related accident). He was treated with an ALT flap and double-barrelled vascularized fibula graft, which was complicated with an additional fracture and breakage of osteosynthesis material. Conclusion:Segmental bone defects pose a major, unsolved clinical challenge in orthopaedic, traumasurgical, and plastic surgical practice. Concomitant infections and fractures can be part of the postoperative course. Patients with complex segmental bone defects need to be treated by a multidisciplinary team including at least an (orthopaedic) trauma surgeon, a plastic surgeon, and an infectiologist.

The Use of Free Fibula Flap in Different Extremities and Our Clinical Results

“…Treating nonunions due to segmental bone loss in the radius and ulna is challenging. Although techniques such as bone transport with Ilizarov exist, this technique does not work in avascular bone after infection [22][23][24].…”