Tibial segmental bone defect reconstruction by Ilizarov type bone transport in an induced membrane

The management of combined loss of skin coverage and bone substance in the lower third of the leg is problematic. A recommended sequential strategy associates removal of infected tissue and coverage followed by treatment of the bone defect. We report a technique without microsurgery, using Masquelet's induced membrane technique to manage the bone loss, associated to bone transport and coverage by a fasciocutaneous flap with distal pedicle. In a patient presenting with a 10 cm defect with bone exposure, this 2-step procedure allowed consolidation at 7 months without functional sequelae; the fixator was kept in place for 9 months. Neither microsurgery nor cancellous bone graft was required. Using a spacer to induce a membrane facilitated bone transport and distal consolidation.