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Reconstruction of composite leg defects post-war injury

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Abstract

Background

In a high conflict region, war injuries to the distal lower extremity are a major source of large composite defects involving bone and soft tissues. These defects are at the edge between using a single free flap [osteo-(+/-myo) cutaneous] vs double free flap reconstruction (bone and soft tissue). In this paper, we present our experience and outcomes in treating patients with leg war injury reconstructed using a single free fibula flap.

Methods

Fifteen patients with distal leg composite defects secondary to war injuries were treated between January 2015 and March 2016. All patients were reconstructed using single barrel free fibula osteo-(+/-myo)cutaneous flap where single or double skin paddles were used according to the soft tissue defect requiring coverage.

Results

There were no cases of total or partial flap loss. Complications were limited to three cases including traumatic fibula fracture, venous congestion with negative findings, and residual soft tissue defect requiring coverage. There were no cases of wound dehiscence or infection. Mean follow-up time was 418.8 days. Mean bone healing time was nine months after which patients were allowed full weight bearing.

Conclusion

A single barrel free fibula osteo-(+/-myo)cutaneous flap is a valid and reliable tool for reconstruction composite lower extremity defects post-war injury. Adequate planning of fibula flap soft tissue components (skin, muscle) rearrangement is essential for success in such challenging reconstructions.

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Author notes

  1. Reem A. Karami and Fadi M. Ghieh contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Cairo Street, Beirut, Lebanon

    Reem A. Karami, Fadi M. Ghieh, Rawad S. Chalhoub & Amir E. Ibrahim

  2. Department of Surgery, Division of Orthopedic Surgery, American University of Beirut Medical Center, Cairo Street, Beirut, Lebanon

    Said S. Saghieh & Suhail A. Lakkis

Authors
  1. Reem A. Karami
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  3. Rawad S. Chalhoub
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  4. Said S. Saghieh
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Contributions

All authors significantly contributed to the drafting and revision of the manuscript and approve its final form.

Corresponding author

Correspondence to Amir E. Ibrahim.

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The research was approved by the Institutional Review Board of the American University of Beirut Medical Center.

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Video 1

Raising the propeller flap from the fibula flap skin paddle based on the distal perforator then checking the pulse with doppler. (MP4 68720 kb)

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Karami, R.A., Ghieh, F.M., Chalhoub, R.S. et al. Reconstruction of composite leg defects post-war injury. International Orthopaedics (SICOT) 43, 2681–2690 (2019). https://doi.org/10.1007/s00264-019-04423-w

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  • DOI: https://doi.org/10.1007/s00264-019-04423-w

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