Cross-leg Ilizarov limb-salvage technique for management of combined bone and soft-tissue distal tibial defect: a case series

Abstract

Background: Management of concomitant distal tibial bony and soft-tissue defects is still a major challenge for both orthopaedic and plastic surgeons. A cross-leg flap can be used as an alternative solution, particularly when the microsurgical free flap is not a feasible or applicable option. The proposed modified bilateral Ilizarov frame with cross-connection bridges provides stability to the construct and treats both soft-tissue and bone defect. Methods: Seven patients presented with combined posttraumatic bone and soft-tissue defects in the distal part of the leg. The defects were managed by cross-leg soft-tissue flap through two-stage procedures. Ilizarov external fixators were used for fixation of both legs to provide stability to the crossing soft-tissue flap and for bone segment transfer to manage bone defects at the same time. Results: In all patients, the soft-tissue flaps were successfully taken 3 weeks postoperatively. In six patients, bone segment transfer took 9 to 12 mo to unite. One patient had defects in the distal tibia and talus that needed further ankle fusion after the completion of segment transfer. In one patient, bone marrow injection was used to enhance the union, and residual osteomyelitis and nonunion were the end results in one patient. Conclusions: The modified cross-leg Ilizarov technique is shown to be an effective and appropriate method in simultaneous management of combined bone and soft-tissue defects in the distal leg. Level of Evidence: Level IV.