eMedicine Specialties > Plastic Surgery > Lower Extremity Reconstruction
Lower Extremity Reconstruction, Tibia: Multimedia
Updated: Jun 27, 2008
Multimedia
 | Media file 1: Clinical Case 1. Preoperative radiograph of the traumatized leg. A multiple segmental and exposed spiral fracture of the tibia is identified (Gustilo stage 3c). |
 | Media file 2: Clinical Case 1. Radiograph of the reduced fracture. Anteroposterior radiograph of the fractured leg after reduction and immobilization with an external fixation device. Pseudoarthrosis of the tibia. |
 | Media file 3: Clinical Case 1. Early postoperative view of the emergency management of a middle-third tibial fracture. Reduction of the fracture and skin grafting to the defect. |
 | Media file 4: Clinical Case 1. Radiologic evidence of the pseudoarthrosis. Laterolateral radiograph of tibial pseudoarthrosis that shows bone nonunion and anterior bowing. |
 | Media file 5: Clinical Case 1. Preoperative picture. Lateral view of the left leg, which now has pseudoarthrosis with anterior bowing of the tibia at its middle third. |
 | Media file 6: Clinical Case 1. Preoperative drawing. Schematic drawing of the preoperative defect and of the planned contralateral flap. |
 | Media file 7: Clinical Case 1. Preoperative view of the donor leg with schematic drawing of the osteocutaneous peroneal flap. |
 | Media file 8: Clinical Case 1. Postoperative drawing. Schematic drawing of the postoperative desired outcome at the recipient and donor areas. |
 | Media file 9: Clinical Case 1. Intraoperative picture. The osteocutaneous peroneal flap synthesized to the recipient site, with its skin island. |
 | Media file 10: Clinical Case 1. Early postoperative radiograph of the operated leg in anteroposterior view. The peroneal flap is easily identified after being infibulated into tibial stumps. |
 | Media file 11: Clinical Case 1. Postoperative picture. Lateral view of the left leg 1 month after surgery. |
 | Media file 12: Clinical Case 1. Postoperative radiograph (1 mo) of the leg. Anteroposterior radiograph of the tibia, which shows satisfactory bone alignment and healing 1 month after surgery. |
 | Media file 13: Clinical Case 2. Preoperative picture. Medial view of the left leg with exposed fracture of the inferior third of the tibia (Gustilo stage 3c) and loss of skin cover. |
 | Media file 14: Clinical Case 2. Preoperative picture. Lateral view of the left leg with exposed fracture of the inferior third of the tibia (Gustilo stage 3c). |
 | Media file 15: Clinical Case 2. Preoperative radiograph of the traumatized leg after early debridement and immobilization with external fixation. Shown is a double complete fracture of the tibia and fibula at their inferior third with loss of substance (Gustilo stage 3c). |
 | Media file 16: Clinical Case 2. Preoperative drawing. Schematic drawing of the preoperative bone defect and the planned contralateral flap. |
 | Media file 17: Clinical Case 2. Early postoperative radiograph of the operated leg in anteroposterior view. The peroneal flap is easily identified after being infibulated into tibial stumps. |
 | Media file 18: Clinical Case 2. Postoperative picture. Postoperative result in anteroposterior view. |
 | Media file 19: Clinical Case 2. Late postoperative radiograph. Anteroposterior radiograph of the tibia 6 months after surgery, with a satisfactory bone alignment and union. |
 | Media file 20: Clinical Case 2. Postoperative picture. Medial view of postoperative result. |
 | Media file 21: Clinical Case 2. Preoperative picture. Frontal view of the right leg with a wide defect of the superior third of the tibia resulting from segmental exposed fracture (Gustilo stage 3c). |
 | Media file 22: Clinical Case 3. Preoperative radiograph of the traumatized leg after early debridement and immobilization with external and internal synthesis. A displaced spiral fracture of the superior third of the tibia with loss of bone tissue is evident (Gustilo stage 3c). |
 | Media file 23: Clinical Case 3. Preoperative drawing. Schematic drawing of the preoperative bone defect and the planned contralateral flap. |
 | Media file 24: Clinical Case 3. Preoperative view of the left donor leg with schematic drawing of the osteocutaneous peroneal flap. |
 | Media file 25: Clinical Case 3. Intraoperative picture of the flap. Intraoperative view of the harvested peroneal osteocutaneous flap. |
 | Media file 26: Clinical Case 3. Postoperative drawing. Schematic drawing of the desired postoperative outcome at the recipient and donor areas. |
 | Media file 27: Clinical Case 3. Postoperative radiograph of the operated leg in anteroposterior view. The peroneal flap is easily identified after being infibulated into tibial stumps. |
 | Media file 28: Clinical Case 3. Anteroposterior radiograph of the tibia 6 months after surgery, with a satisfactory bone alignment and union. |
 | Media file 29: Clinical Case 3. Postoperative result in anteroposterior view with the leg bearing full body weight. |
 | Media file 30: Clinical Case 4. Osteomyelitis of the middle third of the tibial shaft. Shown is a long-standing osteocutaneous fistula secreting pus. |
 | Media file 31: Clinical Case 4. Preoperative planning. Drawing of a right rectus abdominis muscle flap based on the inferior epigastric pedicle. |
 | Media file 32: Clinical Case 4. Intraoperative picture. The right rectus abdominis flap isolated on its vascular pedicle. |
 | Media file 33: Clinical Case 4. Postoperative result. Oblique view of the perfectly healed rectus abdominis muscle flap transferred in place and covered by a meshed split-thickness skin graft. |
 | Media file 34: Fracture of the tibial plate and fibular head. |
 | Media file 35: Early postoperative radiograph after fixation of the tibial fractures with a plate. |
 | Media file 36: Infection and exposure of the plate through the surgical access site. |
 | Media file 37: Posterior approach to the lateral head of the gastrocnemius. |
 | Media file 38: The lateral head of the gastrocnemius is dissected and pedunculated proximally on the lateral sural artery. The soleus muscle is visible at the donor site. |
 | Media file 39: The lateral head of the gastrocnemius is transferred anteriorly, by lateral rotation under the skin, to cover the plate and the fracture lines. |
 | Media file 40: Meshed split-thickness skin graft is applied to the exposed row surface of the gastrocnemius. |
 | Media file 41: Drawing of the reverse sural fasciocutaneous flap, vascularized from distal peroneal perforators. |
 | Media file 42: Skin marking of a large reverse sural flap. |
 | Media file 43: Incision is carried out through the skin down to the muscle fascia, to include the fascia of the leg into the flap. |
 | Media file 44: Frontal view of large scarred area of the leg undergoing frequent breakdowns, with possible malignant transformation. |
 | Media file 45: Medial view of the scarred area of the leg. |
 | Media file 46: Lateral view of the scarred area of the leg. Perforators from the peroneal artery are identified along the lateral septum of the leg with the aid of a superficial Doppler probe. |
 | Media file 47: Frontal view of postoperative results of the scarred area replaced by the reverse sural fasciocutaneous flap. |
 | Media file 48: Postoperative medial view showing the proximal tip of the flap. |
 | Media file 49: Postoperative lateral view showing the distal narrow pedicle of the flap. |
 | Media file 50: Donor area of the reverse sural flap repaired with a meshed split-thickness skin graft. |
More on Lower Extremity Reconstruction, Tibia |
| Overview: Lower Extremity Reconstruction, Tibia |
| Treatment: Lower Extremity Reconstruction, Tibia |
| Follow-up: Lower Extremity Reconstruction, Tibia |
 Multimedia: Lower Extremity Reconstruction, Tibia |
| References |
| « Previous Page |
References
Ostrup LT, Fredrickson JM. Distant transfer of a free, living bone graft by microvascular anastomoses. An experimental study. Plast Reconstr Surg. Sep 1974;54(3):274-85. [Medline].
Taylor GI, Miller GD, Ham FJ. The free vascularized bone graft. A clinical extension of microvascular techniques. Plast Reconstr Surg. May 1975;55(5):533-44. [Medline].
Chen ZW, Yan W. The study and clinical application of the osteocutaneous flap of fibula. Microsurgery. 1983;4(1):11-6. [Medline].
Bovet JL, Schoofs M, Baudet J. [Experimental study of transplantation of the fibula by means of vascular microsurgery in the dog]. Ann Chir Plast. 1982;27(3):279-83. [Medline].
Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma. Aug 1984;24(8):742-6. [Medline].
Byrd HS, Spicer TE, Cierney G 3rd. Management of open tibial fractures. Plast Reconstr Surg. Nov 1985;76(5):719-30. [Medline].
Enneking WF. Musculoskeletal tumor staging: 1988 update. Cancer Treat Res. 1989;44:39-49. [Medline].
Cierny G 3rd, Mader JT. Approach to adult osteomyelitis. Orthop Rev. Apr 1987;16(4):259-70. [Medline].
Boyd HB. Pathology and natural history of congenital pseudarthrosis of the tibia. Clin Orthop Relat Res. Jun 1982;5-13. [Medline].
Enneking WF, Eady JL, Burchardt H. Autogenous cortical bone grafts in the reconstruction of segmental skeletal defects. J Bone Joint Surg Am. Oct 1980;62(7):1039-58. [Medline].
Banic A, Hertel R. Double vascularized fibulas for reconstruction of large tibial defects. J Reconstr Microsurg. Nov 1993;9(6):421-8. [Medline].
Lee KS, Park JW. Free vascularized osteocutaneous fibular graft to the tibia. Microsurgery. 1999;19(3):141-7. [Medline].
Han CS, Wood MB, Bishop AT, et al. Vascularized bone transfer. J Bone Joint Surg Am. Dec 1992;74(10):1441-9. [Medline].
Weiland AJ, Moore JR, Daniel RK. Vascularized bone autografts. Experience with 41 cases. Clin Orthop Relat Res. Apr 1983;87-95. [Medline].
Gilbert A, Wood L. Vascularized transfer of the fibular shaft. Int J Microsurg. 1979;1:100-2.
Morrissy RT, Riseborough EJ, Hall JE. Congenital pseudarthrosis of the tibia. J Bone Joint Surg Br. 1981;63-B(3):367-75. [Medline].
Anthony JP, Rawnsley JD, Benhaim P, et al. Donor leg morbidity and function after fibula free flap mandible reconstruction. Plast Reconstr Surg. Jul 1995;96(1):146-52. [Medline].
Babovic S, Johnson CH, Finical SJ. Free fibula donor-site morbidity: the Mayo experience with 100 consecutive harvests. J Reconstr Microsurg. Feb 2000;16(2):107-10. [Medline].
Bieber EJ, Wood MB. Bone reconstruction. Clin Plast Surg. Oct 1986;13(4):645-55. [Medline].
Buckley SL, Smith GR, Sponseller PD, et al. Severe (type III) open fractures of the tibia in children. J Pediatr Orthop. Sep-Oct 1996;16(5):627-34. [Medline].
Burchardt H. The biology of bone graft repair. Clin Orthop Relat Res. Apr 1983;28-42. [Medline].
Byrd HS, Cierny G 3rd, Tebbetts JB. The management of open tibial fractures with associated soft-tissue loss: external pin fixation with early flap coverage. Plast Reconstr Surg. Jul 1981;68(1):73-82. [Medline].
Chang MC, Lo WH, Chen CM, et al. Treatment of large skeletal defects in the lower extremities using double-strut, free vascularized fibular bone grafting. Orthopedics. Aug 1999;22(8):739-44. [Medline].
Chung YK, Chung S. Ipsilateral island fibula transfer for segmental tibial defects: antegrade and retrograde fashion. Plast Reconstr Surg. Feb 1998;101(2):375-82; discussion 383-4. [Medline].
Cierny G 3rd, Byrd HS, Jones RE. Primary versus delayed soft tissue coverage for severe open tibial fractures. A comparison of results. Clin Orthop. Sep 1983;(178):54-63. [Medline].
Cormack GC, Lamberty BGH, eds. Chapter 6. In: The Arterial Anatomy of Skin Flaps. ed. New York, NY: Churchill Livingstone; 1986.
Disa JJ, Cordeiro PG, Hidalgo DA. Efficacy of conventional monitoring techniques in free tissue transfer: an 11-year experience in 750 consecutive cases. Plast Reconstr Surg. Jul 1999;104(1):97-101. [Medline].
Godina M. Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg. Sep 1986;78(3):285-92. [Medline].
Gustilo RB. Fracture Classification Manual. St. Louis, Mo: Mosby-Year Book; 1991.
Harrison DH. Microvascular transfer of fibular bone grafts. J R Soc Med. Apr 1983;76(4):249-51. [Medline].
Hsieh CH, Jeng SF, Chen SH, et al. Folded free vascularized fibular grafts for the reconstruction of combined segmental bone defects of distal tibia and fibula. J Trauma. Feb 2004;56(2):437-9. [Medline].
O'Brien BMcC. Microvascular Reconstructive Surgery. New York, NY: Churchill Livingstone; 1977.
O'Brien BMcC, Morrison WA, Pribaz JJ. Double fibula bone grafting for large bone defects. Annual General Scientific Meeting. Royal Australasian College of Surgeons. Melbourne, Australia: 1984.
Organek AJ, Klebuc MJ, Zuker RM. Indications and outcomes of free tissue transfer to the lower extremity in children: review. J Reconstr Microsurg. Apr 2006;22(3):173-81. [Medline].
Schusterman MA, Reece GP, Miller MJ, et al. The osteocutaneous free fibula flap: is the skin paddle reliable?. Plast Reconstr Surg. Nov 1992;90(5):787-93; discussion 794-8. [Medline].
Tamai S. Vascularized fibula transplantation for congenital pseudoarthrosis and radial club hand. In: Buncke H, Furnas D, eds. Symposium on Clinical Frontiers in Reconstructive Microsurgery. St. Louis, Mo: Mosby-Year Book; 1984.
Ueba Y, Fujikawa S. Nine years follow up of a free vascularized fibular graft in neurofibromatosis - a case report and literature review. Jpn J Orthop Trauma Surg. 1983;26:595-600.
Weiland AJ, Phillips TW, Randolph MA. Bone grafts: a radiologic, histologic, and biomechanical model comparing autografts, allografts, and free vascularized bone grafts. Plast Reconstr Surg. Sep 1984;74(3):368-79. [Medline].
Further Reading
Keywords
tibial reconstruction, tibia reconstruction, lower leg reconstruction, leg reconstruction, cancellous bone grafting, external fixation, leg amputation, tibial injury, tibia injury, vascularized fibular transfer, complex tibia fracture, complex tibial fracture, tibia fracture, tibial fracture, traumatic fracture, bone tumor, osteomyelitis, pseudoarthrosis, pseudo-arthrosis, cosmetic surgery, leg reconstruction, flap graft, muscle flap, muscle-skin flap, musculocutaneous flap, cutaneous flap
