PURPOSE: Combined Ilizarov external fixation and microsurgical soft tissue coverage can treat lower extremities previously deemed unsalvageable. Outcome analysis of a large series of combined Ilizarov bone transport and microsurgical salvage of complex lower extremity wounds.

METHODS: Retrospective review of Gustillo IIIB/IIIC injuries, post-ablative defects or chronic osteomyelitis requiring Ilizarov reconstruction and free tissue transfer from 1995-2005. Detailed evaluation of patient characteristics, bone transport, microsurgical procedures and outcome.

RESULTS: Seventy-eight patients (M:F=3:1); average age 41 years (range 15-72) were identified. Complications from inadequate treatment of Gustillo I-II injuries elsewhere converted many patients to IIIB. Mean segmental regenerate was 7.1cm; time-in-frame, 9.7 months. Microsurgical coverage included 48.6% rectus abdominis, 36.5% latissimus dorsi, 9.4% gracilis, 1.4% serratus anterior and 4.1% partial muscle flaps. All flaps survived; 88% of docking sites achieved primary union. Functional and aesthetic outcome of patients with greater than two years' follow-up will be presented in detail using a modified Puno system.

CONCLUSIONS: This is the largest reported series of combined Ilizarov bone transport and free tissue transfer for complex lower extremity salvage. Initial inappropriate fixation and/or soft tissue management at referring facilities often produced more significant defects. Combined frame-and-flap treatment was successful in all cases. Salvage of complex lower extremity problems with significant bony and soft tissue defects using Ilizarov bone transport and free tissue transfer is both feasible and reliable. Microsurgical advances such as partial muscle flaps preserve function at the donor site while providing reliable vascular coverage.