title: Composite vascularised osteocutaneous fibula and sural nerve graft for severe open tibial fracture--functional outcome at one year: a case report.
abstract: Management of severe open tibial fracture with neurovascular injury is difficult and controversial. Primary amputation is an acceptable option as salvaging the injured, insensate, and ischaemic limb may result in chronic osteomyelitis and non-functional limb. We report a case of open tibial fracture associated with segmental bone and soft tissue loss, posterior tibial nerve and artery injuries, which was further complicated by chronic osteo-myelitis treated with composite vascularised osteocutaneous fibula and sural nerve graft. Functional outcome of the injured limb at one-year follow-up was satisfactory: the patient was capable of achieving full weightbearing and was able to appreciate crude touch, pain, proprioception, and temperature at the plantar aspect of the foot. There was no pressure sore or ulceration.
authors.affiliation: Reconstructive Sciences Unit, School of Medical Science, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia.
authors.forename: A S
authors.initials: AS
authors.lastname: Halim
authors.forename: I
authors.initials: I
authors.lastname: Yusof
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D016025:Bone Transplantation / Q000379:methods*; D003131:Combined Modality Therapy; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery; D005360:Fibula / Q000098:blood supply* / Q000293:injuries / Q000601:surgery / Q000637:transplantation*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D005597:Fractures, Open / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009104:Multiple Trauma / Q000000981:diagnostic imaging / Q000601:surgery; D019635:Neurosurgical Procedures; D011859:Radiography; D018570:Risk Assessment; D013497:Sural Nerve / Q000637:transplantation*; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000601:surgery; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology