Reconstruction of major traumatic segmental bone defects of the tibia with vascularized bone transfers.

BACKGROUND: Segmental bone defects of the tibia after high-energy trauma are limb-threatening conditions. Multiple treatment options have been proposed, including nonvascularized bone grafts, vascularized bone transfers, and callus distraction. A series of 41 patients with major segmental defects of the tibia treated with vascularized bone reconstruction is presented.

METHODS: Forty-one acute or nonacute segmental bone defects of the tibia, 4 cm or more in length, were included in the series. In acute defects (nine cases), a single-stage or two-stage reconstruction with vascularized bone transfer was performed. In nonacute segmental infected bone defects (32 cases), single-stage reconstruction with vascularized bone transfer (seven cases) or two-stage reconstruction with vascularized bone transfer (25 cases) was performed. Reconstruction was performed with fibular flaps in 38 cases (36 contralateral free and two ipsilateral pedicled flaps) and iliac flaps in three cases. Bone fixation was performed with screws and external fixation, with early conversion to locking plate internal fixation.

RESULTS: Two fibular flaps needed urgent revision for venous congestion. One fibular flap was lost. Infection after vascularized bone transfer occurred in two delayed reconstructions. Bone healing occurred in all cases. Stress fractures occurred in three fibular flaps. Time to bone union was 5 to 9 months, and time to full weight bearing was 9 to 14 months.

CONCLUSIONS: The use of vascularized bone transfer in the treatment of major segmental tibial defects was successful in the present series. The management of bone fixation and infection in these cases is discussed.