Management of massive trauma over lower extremity with free flap and Ilizarov method

Twenty-six patients with massive combat injuries to the lower extremities were treated with Ilizarov bone transport and free flap coverage. In all cases, debridement was performed thoroughly and with caution, followed by free flap coverage and external fixator application. The Ilizarov transport method using ring fixators was applied 4-6 weeks later, with distraction osteogenesis beginning 2-3 days later. The segmental bone defects ranged from 5cm to 16cm in the greatest dimension, and the total disability time from initial injury ranged from 14-26 months. However, two patients experienced partial flap necrosis, which was later treated with local transposition flap cover and split skin graft. Despite the late treatment, successful results were obtained in all 26 patients, with the original length of the tibia maintained and timely definitive treatment provided for the massive injuries of the lower extremities. Thus, the Ilizarov transport method used in combination with free flap coverage provides an effective therapy for repairing massive injuries to the lower extremities.