Long-Term Results and Costs of Muscle Flap Coverage With Ilizarov Bone Transport in Lower Limb Salvage

Abstract

To determine long-term outcomes and costs of Ilizarov bone transport and flap coverage for lower limb salvage. Case series with retrospective review of outcomes with at least 6-year follow-up. Academic tertiary care medical center. Thirty-four consecutive patients with traumatic lower extremity wounds and tibial defects who were recommended amputation but instead underwent complex limb salvage from 1993 to 2005. Flap reconstruction and Ilizarov bone transport. Outcomes assessed were flap complications, infection, union, malunion, need for chronic narcotics, ambulation status, employment status, and need for reoperations. A cost analysis was performed comparing this treatment modality to amputation. Thirty-four patients (mean age: 40 years) were included with 14 acute Gustilo IIIB/C defects and 20 chronic tibial defects (nonunion with osteomyelitis). Thirty-five muscle flaps were performed with 1 flap loss (2.9%). The mean tibial bone defect was 8.7 cm, mean duration of bone transport was 10.8 months, and mean follow-up was 11 years. Primary nonunion rate at the docking site was 8.8% and malunion rate was 5.9%. All patients achieved final union with no cases of recurrent osteomyelitis. No patients underwent future amputations, 29% required reoperations, 97% were ambulating without assistance, 85% were working full time, and only 5.9% required chronic narcotics. Mean lifetime cost per patient per year after limb salvage was significantly less than the published cost for amputation. The long-term results and costs of bone transport and flap coverage strongly support complex limb salvage in this patient population.