[Complex tissue reconstruction of the arm with free vascularized fibular graft with skin island]

Results of treatment for postraumatic bone and soft tissue defects within the arm in 3 patients (1 female, 2 males aged 20-30 years (mean 25 years), are presented. In both male patients osteomyelitis and irreversible radial nerve lesion was present. Stage 1 included radical excision of inflamed tissues. When the inflammation ceased reconstructive treatment has been initiated. Tendon transposition has been performed to restore writ and fingers extension. After several months free vascularized fibular graft (11-17 cm in length) was used to reconstruct bone and soft tissues of the arm. Zespol fixator has been used in two cases. Marginal skin island necrosis has been noted twice. Screw tract infection or lack of bony union in proximal end of the graft required re-operation. Bony union has been observed already in the 3rd month postoperatively but final incorporation and hypertrophy of the graft occurred after 6-26 months, (mean 14 months). In all cases final results were rated as excellent.