Reconstruction of large infected tibia defects.

Twenty-nine patients are reported who underwent free tissue transfer reconstruction of contaminated tibia defects with both soft tissue defects and osteomyelitis. Infection was controlled through the use of a two-stage composite tissue reconstruction. In the first stage, the wounds were closed with the free muscle or skin flap. Bone defects were bridged with vascularized bone grafts within 6 to 12 weeks after soft tissue closure. Twenty patients underwent reconstruction using iliac crest, whereas nine patients were treated with fibular transfer. The follow-up period for 28 patients ranged from 10 months to 6 years until bone union was completed. The bone united smoothly in 22 patients, but union of the other six grafts was delayed and required additional cancellous bone grafting.