A combined use of a free vascularised flap and an external fixator for reconstruction of lower extremity defects in children

Journal of Orthopaedic Surgery, Aug 2007 by Segev, E, Wientroub, S, Kollender, Y, Meller, I, Et al

DISCUSSION

Well-established free flaps can withstand bone transfer and limb lengthening if they are located below the active lengthening zone.3,8,9 The combined use of free tissue transfer and an Ilizarov frame to correct severe equinus contracture has been reported.10 The Achilles tendon was lengthened, followed by free flap transfer and Ilizarov frame application either immediately or after 3 months.11-13 All 9 of their patients achieved a plantigrade foot, but the Ilizarov apparatus for correction of equinus contracture was shown to be effective.14 Burn injuries of the lower leg have higher recurrence rates.15 The preventive use of ankle fixation is also advocated during leg lengthening.16

Two of our patients developed equinus contractures years after removal of the external fixator, despite the routine use of an orthosis. Distraction using the Ilizarov circular frame successfully corrected the equinus contractures in the presence of a free flap, without Achilles tendon lengthening, soft tissue release, or osteotomy. The distraction and equinus correction were uneventful; there was no ischaemia or complication affecting the free flap and surrounding soft tissues.

CONCLUSION

Well-established free flaps of the leg can withstand stretch forces from distraction during correction of equinus contractures. When external fixation and free flap reconstruction of the lower extremities is performed, the foot should also be stabilised to prevent equinus contracture. Despite having protective bracing, equinus contracture can develop after removal of the external fixator. Reapplying the frame can enable effective dynamic correction, with no harm to the free flap.

REFERENCES

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