title: Combined single-stage osseous and soft tissue reconstruction of the tibia with the Ilizarov method and tissue transfer.
abstract: OBJECTIVE
  To determine the outcome of single-stage soft tissue and osseous reconstruction using the Ilizarov method and soft-tissue transfer.
  
  
  METHODS
  A retrospective review.
  
  
  METHODS
  : A university-affiliated, tertiary-care center.
  
  
  METHODS
  We identified 11 patients from a retrospective review from January 1994 to July 1999 who underwent single-stage soft tissue and osseous reconstruction using the Ilizarov method. All 11 patients had an initial traumatic mechanism to their tibia and had previous operative intervention before the combined procedure. The Ilizarov procedure was performed for infected tibial nonunion (8 cases), or complex fracture with soft-tissue loss (3 cases).
  
  
  METHODS
  Soft tissue transplant survival, union, range of motion, leg length discrepancy, the Association for the Study and Application of the Method of Ilizarov (ASAMI) score, radiographic parameters.
  
  
  RESULTS
  There were 8 concomitant free tissue flaps and 3 local pedicled flaps. Two patients had primary bone grafting, and 5 others had addition of an antibiotic impregnated bone substitute. There were 8 cases of elective reconstructive surgery and 3 cases of acute traumatic fracture. The mean duration of Ilizarov application was 26 weeks (range, 7 to 42). Eight tibiae united primarily, and 3 healed after delayed bone grafting. There were 2 major flap complications. Both were successfully managed with repeat surgery. One patient sustained a repeat open fracture and subsequently received an amputation. According to the ASAMI score, there were 9 excellent results, 1 good result, and 1 poor result.
  
  
  CONCLUSIONS
  Our study suggests that concomitant osseous and soft-tissue reconstruction with the Ilizarov technique and free or pedicled flaps is a viable option for patients with composite tissue defects.
authors.affiliation: Division of Orthopaedics, St. Michael's Hospital and the University of Toronto, Toronto, Ontario, Canada. mckeem@smh.toronto.on.ca
authors.forename: Michael D
authors.initials: MD
authors.lastname: McKee
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Yoo
authors.forename: Rad
authors.initials: R
authors.lastname: Zdero
authors.forename: Marc
authors.initials: M
authors.lastname: Dupere
authors.forename: Lisa
authors.initials: L
authors.lastname: Wild
authors.forename: Emil H
authors.initials: EH
authors.lastname: Schemitsch
authors.forename: James
authors.initials: J
authors.lastname: Mahoney
mesh_terms: D000328:Adult; D000368:Aged; D001861:Bone Regeneration; D018786:Bone Substitutes / Q000627:therapeutic use; D016025:Bone Transplantation; D015331:Cohort Studies; D005260:Female; D006801:Humans; D018889:Ilizarov Technique; D007870:Leg Length Inequality / Q000209:etiology; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps; D013978:Tibial Fractures / Q000628:therapy*; D019737:Transplants; D016896:Treatment Outcome
chemical_list: D018786:Bone Substitutes