title: Bone propeller flap: a staged procedure.
abstract: The ideal reconstruction technique for complex defects of the lower limb consists of replacing tissue with similar tissue in an attempt to achieve a good functional result. A 23-year-old white male sustained a crush injury with a grade IIIB open ankle dislocation. After open reduction and fixation, the patient developed severe osteomyelitis at the tibiotalar joint requiring a staged and radical debridement with a substantial combined soft tissue and bony defect over the distal tibia, fibula, and talus area. The reconstructive approach consisted of a modified model of the propeller flap, implementing the spare part concept in a 2-stage procedure using a prefabricated and vascularized "double-barrel" fibular graft. At 17 months postoperatively, a plain radiograph showed bony union with complete and stable coverage of the soft tissue defect. The patient was fully weightbearing. In conclusion, there is evidence to suggest that the established concept of a soft tissue propeller flap can be implemented on bone.
authors.affiliation: Department of Plastic, Reconstructive Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland.
authors.forename: Mathias
authors.initials: M
authors.lastname: Tremp
authors.affiliation: Department of Plastic, Reconstructive Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland.
authors.forename: René D
authors.initials: RD
authors.lastname: Largo
authors.affiliation: Orthopedic and Traumatology Department, Septic Surgical Unit, University Hospital Center and University of Lausanne, Lausanne, Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: Borens
authors.affiliation: Department of Plastic, Reconstructive Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Schaefer
authors.affiliation: Department of Plastic, Reconstructive Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland. Electronic address: dkalbermatten@uhbs.ch.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Kalbermatten
mesh_terms: D000843:Ankle Joint; D005597:Fractures, Open / Q000150:complications / Q000601:surgery*; D006801:Humans; D004204:Joint Dislocations / Q000150:complications / Q000601:surgery*; D008297:Male; D010019:Osteomyelitis / Q000209:etiology / Q000382:microbiology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D055815:Young Adult
keywords: Masquelet; free flap; latissimus dorsi flap; staged reconstruction