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Page 12 of 18 Stoneburner et al. Plast Aesthet Res 2020;7:13 I http://dx.doi.org/10.20517/2347-9264.2019.028

Case #1
Case #2
Case #3
31
45
69
(yrs)
Age
DISCUSSION
nonunion
Chronic OM
Acute trauma
Indication
Chronic OM and
Table 7. Summary of cases series
NR
6 mo
injury
40 yrs
Time from
working with physical therapy [Table 7].
8 cm
11.5 cm
Bone
defect
17.5 cm
75 cm 2
defect
Case 3: free latissimus dorsi with ilizarov frame first
100 cm 2
500 cm 2
Soft tissue
frame
frame
Taylor
Frame
precise
spatial
Ilizarov
NuVasive Flap first
Frame first
Frame first
transport, is fully weight bearing, and participating in physical therapy.
Surgical
approach
Free LD
Free LD;
Free ALT
Flap
rotational gastroc
PT
AT
PT
vessel
Recipient
NR
NR
rate
0.5-1 mm/day
Distraction
Antibiotic
bony union
Skin grafting
spacer; STSG
Management

distraction and bone graft
Complications
quadricepsplasty; infection
Flap elevation and bone grafting
Nonunion requiring reoperation for
Masquelet for Tendon lengthening; ankle spanning
external fixation; 2 lysis of adhesions;

result
Ultimate
OM: osteomyelitis; LD: latissimus dorsi; gastroc: gastrocnemius; SPSG: split thickness skin graft; yrs: years; mo: months; PT: posterior tibial; AT: anterior tibial; NR: not reported; ALT: anterolateral thigh
Weight bearing
Weight bearing
Weight bearing
prepared for soft tissue coverage. One week after external fixation, he underwent free latissimus dorsi muscle flap with microvascular anastomosis in end-to-
He subsequently underwent two more debridements as well as removal of internal antibiotic coated nail and placement of multiplanar ringed external
This systematic review evaluates the choices for soft tissue coverage in distraction osteogenesis for upper and lower extremities, and presents both indicators
of success (weight bearing status and satisfaction) and complication rates to better inform the surgeon’s decision-making process. The indications for surgical
intervention include chronic nonunion, osteomyelitis, and, less commonly, acute trauma. Fewer articles detailed reconstruction after acute trauma, which was
simultaneous bone grafting to the docking site. Since that time, he has been distracting and has reached equal limb length. He has been weight bearing and
to be closed and ultimately a rotational flap was employed for closure. He thereafter developed infection and remained non-weightbearing. He was told
that amputation was his only option, which he refused, and approximately 6 months after his initial fixation, he presented to our clinic to discuss limb salvage
stabilization with an external fixator, which two weeks later was converted to internal fixation. At the time of definitive fixation, the wounds were not able
transport nail. He went to the operating room 77 days later for preparation of the docking site as well as bone grafting from the iliac crest. He has completed
A 31-year-old man sustained a right distal tibia/fibula fracture from a motorcycle crash, treated at that time at an outside facility with debridement and
fixator. He was ultimately left with a bony defect of approximately 11.5 cm and soft tissue defect of approximately 500 cm 2 , at which point he was determined
end fashion to the posterior tibial vessels as well as skin grafting for coverage. He underwent corticotomy in preparation for bony transport 42 days after his
options. He was found at that time to have osteomyelitis and nonunion of his tibial fracture. His wounds had many sinus tracts, which were draining purulent
effluent. He was taken to the operating room for debridement, hardware removal, and antibiotic-impregnated nail placement at the diaphyseal tibial fracture.
free flap, and subsequently initiated transport 55 days after his free flap. He received one additional surgery for elevation of the flap out of the docking site and