Reverse sural flap with simultaneous open bone transport in the leg: A novel method

Abstract

Background: Successful management of extensive bony and soft tissue loss in the leg is challenging. The authors would like to describe a novel technique of open bone transport used simultaneously with a reverse-flow sural neurocutaneous flap to achieve limb salvage. Method: A 40-year-old male patient had sustained a Gustilo IIIC left proximal tibial fracture with anterior soft tissue loss following a road traffic accident. Open bone transport was performed together with a reverse-flow sural neurocutaneous flap to close both bony and soft tissue defects simultaneously.Results: We faced challenges of soft tissue invagination and over-distraction during the process. They were overcome by employing the K-wiring technique and the Accordion Manoeuvre respectively. The flap remained healthy and the soft tissue defect gradually healed. The bone transport segment was docked with both injury and corticotomy sites showing good bony healing.Conclusion: Open bone transport was successfully employed with a reverse sural flap to achieve limb salvage in this patient. This technique can be considered in patients with significant bone loss and significant anterior soft-tissue defects which are not amenable to free soft tissue coverage due to single vessel runoff and the risk of vascular steal.