ACTA FAC MED NAISS 2008; 25 (4): 173-177

Original article

TREATMENT OF COMPLEX WAR WOUNDS OF THE LOWER LEG WITH FREE FLAPS AND ILIZAROV METHOD – OUR EXPERIENCE

Jefta Kozarski¹
Milomir Kosutic²
Vladimir Stojiljkovic¹


Clinic for Plastic Surgery and Burns¹,
Clinic of Traumatology and Orthopedics ²
Military Medical Academy,Belgrade

  SUMMARY

Indications for free flaps and Ilizarov method were severe bone fractures with extensive soft tissue defects and segmental bone defects longer than 4cm. The tissue defects of lower leg were classified as Gustillo IIIB and Gustillo IIIC. We used free flaps and Ilizarov method in treating 27 wounded subjects with vast tissue defects of lower leg at the Clinic of Plastic Surgery and Burns and Clinic of Traumatology and Orthopedic Surgery, with the aim of closing war wounds, covering deep structures and making the preconditions for later reconstruction of bone structures. Three months after the free flap transfer, we performed corticotomy and distraction of the longer (proximal or distal) bone segment of tibia. We analyzed types and time of free flaps applied, duration of the bone transport with Ilizarov apparatus, as well as the quality of reconstructed bone during the five-year follow-up. All of 27 patients that we treated with free flaps and Ilizarov procedure are able to walk independently without orthopedic devices, while the maximal shortening of the leg was 3 cm in 2 (7.4%) patients.
The combination of two revolutionary methods in plastic and orthopedic surgery, the free flap and Ilizarov method is a useful treatment modality, which finds place in treating the war wounds with the extensive tissue defects of the lower leg.

Key words: war wound, free flap, Ilizarov method