Reconstruction of the lower extremity after grade III distal tibial injuries using combined microsurgical free tissue transfer and bone transport by distraction osteosynthesis.

Five patients each with grade IIIB or IIIC distal tibial injuries are presented. All patients were treated initially by multiple debridements and external fixation of the tibial fracture. After failure of the primary treatment, each patient underwent microsurgical free muscle transfer and bone transport of the proximal tibia to reconstruct the lower leg. Soft tissue loss ranged from 8 to 20 cm. Segmental tibial loss ranged from 8 to 18 cm. Free flaps used included rectus abdominis, latissimus dorsi, and combined latissimus dorsi-serratus anterior muscles. Bone transport was accomplished by callus distraction after corticotomy. All patients are ambulatory, fully weight bearing, and without pain (range, 17-34 mo). This treatment method has obviated the need for below-the-knee amputation in all of our patients.