title: Treatment of compound tibia fracture with microvascular latissimus dorsi flap and the Ilizarov technique: A cross-sectional study of long-term outcomes.
abstract: BACKGROUND
  Extensive compound tibial fractures present reconstructive challenges. The present study aimed to assess the outcomes of microvascular latissimus dorsi (LD) flap combined with the Ilizarov technique for extensive compound tibial fractures with bone loss and bone healing complications.
  
  
  METHODS
  Patient records were reviewed retrospectively. The Lower Extremity Functional Scale (LEFS), the Disabilities of the Arm, Hand and Shoulder (DASH), and the 15D health-related quality of life (HRQoL) instrument were applied.
  
  
  RESULTS
  Between 1989 and 2014, 16 patients underwent reconstruction with a microvascular LD flap and bone transport (11/16) or late bone lengthening (5/16). The mean clinical follow-up time was 6.6 (standard deviation (SD): 6.5) years. Three patients had minor complications requiring reoperation. Partial necrosis of one flap required late flap reconstruction in one case. Late bone grafting was used to enhance union in eight of 16 cases. The mean new bone gain was 3.8 cm (SD: 2.5). Overall, 11 patients completed the questionnaires in a mean of 22.3 years (SD: 2.4) after surgery. The main findings revealed a relatively good function of the reconstructed limb and good shoulder function. The mean HRQoL was comparable to that of an age-standardized sample of the general population.
  
  
  CONCLUSIONS
  Segmental tibia transport and lengthening to correct limb length discrepancy do not compromise the microvascular muscle flap. Combined microvascular LD flap reconstruction and the Ilizarov technique can be used in treating acute compound tibial defects, pseudoarthrosis, and osteitis, all associated with significant amputation risk. Fair long-term functional outcomes and HRQoL are achieved when these combined techniques are used.
authors: Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, HUS, Helsinki, Finland. Electronic address: mrjussirepo@gmail.com.
authors: J P
authors: JP
authors: Repo
authors: Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, HUS, Helsinki, Finland.
authors: I
authors: I
authors: Barner-Rasmussen
authors: Group Administration, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Health and Social Management, Research Centre for Comparative Effectiveness and Patient Safety, University of Eastern Finland, Kuopio, Finland.
authors: R P
authors: RP
authors: Roine
authors: Department of Public Health, University of Helsinki, Helsinki, Finland.
authors: H
authors: H
authors: Sintonen
authors: Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, HUS, Helsinki, Finland.
authors: E J
authors: EJ
authors: Tukiainen
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D018889:Ilizarov Technique; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply / Q000637:transplantation*; D011788:Quality of Life; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*; D011795:Surveys and Questionnaires; D013978:Tibial Fractures / Q000601:surgery*; D016896:Treatment Outcome
keywords: Distraction osteogenesis; Ilizarov; Latissimus dorsi; Lower extremity reconstruction; Muscle flap; Tibia fracture