Single-stage microsurgical reconstruction of large complex tissue defects of the lower extremities with two vascularized flaps

Abstract

The purpose of this study was to explore the effectiveness of combined one-stage reconstruction of extensive complex defects of lower limb tissues and to analyze postoperative complications.Material and methods. The research involved 25 patients with bone and soft tissue defects of lower extremities. The first group included 16 patients, where the replacement of bone and soft-tissue defects of the lower leg was carried out with one complex bone-skin graft. The second group consisted of 9 patients who, along with major defects of the tibia, had concomitant extensive damage of soft tissues. To replace bone and soft-tissue limb defects, the autotransplantation technique of 2 free flaps, bone and soft-tissue (combined) was used.Results and discussion. In our study, we analyzed early and late postoperative complications, as well as the average time of fusion of the graft with the recipient bed and restoration time of the lower limb supportability. In the second group of patients, we did not observe any critical complications in the early postoperative period that would affect the results of patient`s treatment. The increase in the incidence of vascular complications is not statistically significant. In the late postoperative period (30 days or more), stress fractures of the fibular graft, traumatic fracture of the fibular graft, delayed consolidation of the graft ends with the recipient bone lasting more than 6 months were observed in both groups of patients. The incidence of these complications was comparable in both groups, there were no statistically significant differences. The average time of fusion of the graft with the recipient bed and the time of restoration of the lower limb supportability did not have statistically significant differences.Conclusion. One-stage reconstruction of extensive deep limb tissue defects by using an appropriate combination of two vascularized complex grafts (bone and soft tissue) provides a complete reconstruction of complex limb tissue defects without increasing the time of bone consolidation and the frequency of occurrence of critical complications in the postoperative period (total necrosis of vascularized flaps and deep wound infection process).