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Page 8 of 18 Stoneburner et al. Plast Aesthet Res 2020;7:13 I http://dx.doi.org/10.20517/2347-9264.2019.028

Table 2. Indications for surgery
Indications for surgery No. of articles No. of extremities Percentage of extremities (%)
Osteomyelitis 9
Nonunion 3 85 58.2
Acute trauma (+/- infection) 9 61 41.8
Total articles 14 146

Table 3. Surgical approach
Surgical approach No. of articles No. of extremities Percentage of extremities (%)
Flap first 9 83 56.8
Simultaneous application of flap and frame 7 54 37.0
Frame first 4 9 6.2
Total articles 14 146

Table 4. Type of flap
Type of flap No. of articles No. of extremities Percentage of extremities (%)
Rectus abdominis 9 47 40.9
Free latissimus dorsi 12 42 36.5
Rotational gastrocnemius 4 11 9.6
Reverse sural 2 3 2.6
Soleus 1 3 2.6
Radial forearm flow-through 2 2 1.7
Rotational latissimus dorsi* 2 2 1.7
Cross leg 2 2 1.7
Serratus 1 1 0.9
Gracilis 1 1 0.9
Combined LD + serratus 1 1 0.9
Total articles 13 115
*Used for upper extremity reconstruction. LD: latissimus dorsi

underwent simultaneous application of frame and soft tissue flap (37.0%) while others had the application
of a flap first (56.8%) or frame first (6.2%) [Table 3]. With respect to soft tissue reconstruction, four of the
2
2
14 articles quantified the soft tissue defect. The average soft tissue defect was 125 cm (range of 88-219 cm ).
All 14 articles discussed the general type(s) of flaps used. Soft tissue reconstruction was most commonly
performed with free flaps (88.0%) as opposed to rotational flaps (12.0%). Of these, most were muscle
flaps (96.7%) with fewer being fasciocutaneous flaps (3.3%). However, only 13 of the 14 articles specified
the type of flap used for each procedure. The most frequently used flaps were free latissimus dorsi and
rectus abdominis, followed by rotational gastrocnemius [Table 4]. Seven of the 14 articles discussed type
of anastomosis. End-to-side anastomosis (55.2%) was performed slightly more often than end-to-end
anastomosis (44.8%), and, while a large range of recipient vessels was used, posterior tibial (53.2%) and
anterior tibial (24.2%) were the most common [Table 5].

With regard to bone reconstruction and transport, bone defect was mentioned in nine articles, whereas total
length of distraction was mentioned in four of the 14 articles. The average bone defect was 8.9 cm (range
of 6.0-12.5 cm) and average total distraction was 6.1 cm (range of 4.3-10 cm). The time to distraction was
discussed in five of the 14 articles, and rate of distraction was discussed in six of the 14 articles. The average
time to distraction was 24.1 days (range of 7-73.5 days) and the average rate of distraction was 0.96 mm/day
(range of 0.75-1 mm/day).

As discussed in 11 of the 14 articles, additional techniques were utilized for some extremities. These
techniques included bone graft (62.3%), antibiotic beads (48.6%), antibiotic bone substitute (13.0%), vein