Combined free flap and ilizarov bone reconstruction in complex lower limb trauma: our experience


  • Ravi Mahajan Department of Plastic Surgery, Amandeep Hospital, Amritsar, Punjab, India
  • Inderdeep Singh Department of Orthopaedic, Amandeep Hospital, Amritsar, Punjab, India
  • Avtar Singh Department of Orthopaedic, Amandeep Hospital, Amritsar, Punjab, India
  • Mahipal Singh Department of Plastic Surgery, Amandeep Hospital, Amritsar, Punjab, India
  • Sandeep Kansal Department of Plastic Surgery, Amandeep Hospital, Amritsar, Punjab, India



Complex lower limb trauma, Ilizarov, Free flap, Complications, Outcome


Background: Reconstruction of complex lower limb trauma is a major concern for both plastic and Orthopedic surgeons. The use of free flap with Ilizarov method for soft tissue coverage and bone reconstruction not only gives the patient near normal shape and function but also allows early mobilization of the patient, even during the process of distraction with Ilizarov method.

Methods: In this study patients with bone and soft tissue defects of the lower leg were included in the study. Our protocol was immediate wound debridement along with application of external fixator and early free flap coverage within 48-72 hours. After 3-4 weeks of the free flap transfer definitive bone reconstruction is done with Ilizarov method.

Results: 122 flaps survived fully and distal flap necrosis occurred in 4 patients. Necrosis of flap occurred before the start of bone reconstruction with Ilizarov and was managed conservatively or with skin graft. Pin tract infection occurred in 45 (35.71%) patients and was treated by pin care and antibiotics. Other complications in treated patients included pain due to distraction (33.33%). delayed union at docking site (11.90%), discrepancy of limb size (9.52%) and union with deformity (6.35%). The functional outcome was satisfactory in majority of the cases.

Conclusions: Combined use of free flap and Ilizarov provides a more reliable soft tissue coverage and bone reconstruction with almost near normal shape and function. It has advantages like regenerating same quality bone and allowing the early mobilization of the patient with acceptable rate of complications.


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Original Research Articles