The combined use of the Ilizarov method and microsurgical techniques for limb salvage.

The purpose of this article is to review clinical outcomes and propose a new classification scheme for combined use of Ilizarov Method with free tissue transfer for limb salvage. This is an Institutional Review Board-approved retrospective review of 62 patients treated with free tissue transfer and Ilizarov method over the past 15 years at a single institution. The surgical management of these patients is classified into 4 distinct approaches. The mean age was 37 years with the most common injury being Gustillo IIIB tibial fractures (61%). Eighty-seven percent of patients had failed prior fixation and 63% had osteomyelitis with a draining wound. The overall flap survival rate was 97%. The mean duration of Ilizarov fixation was 6.9 months with a mean limb length correction of 3 cm. The overall rate of primary bony union was 74%. With a mean follow-up of 42 months, the combined techniques resulted in limb salvage for 84% of cases. Failure of primary bony union was the only predictor of limb amputation. This multidisciplinary approach to limb salvage combines reconstructive microsurgery and the Ilizarov method.