ArticleJournal of surgical case reports2026
Combination of pedicled fibular graft and latissimus dorsi free flap in complex tibial bone defect reconstruction after high-energy trauma: a case report.
Article in Journal of surgical case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
High-energy open tibial fractures with segmental bone loss and extensive soft-tissue necrosis remain limb-threatening, especially when only one recipient artery is patent. We report a 37-year-old man with a Gustilo-Anderson type IIIB open distal tibial fracture, posterior tibial artery injury, a 7-cm tibial defect and a 14 x 25 cm soft-tissue defect after serial debridement. After emergency external fixation and revascularization, the wound was optimized with repeated debridement and circumferential negative-pressure wound therapy. Definitive reconstruction used a vascularized pedicled fibular graft from the injured leg to bridge the tibial defect, combined with a latissimus dorsi free flap for coverage; the thoracodorsal artery was anastomosed end-to-side to the posterior tibial artery under 3D magnification. The flap survived without infection or secondary necrosis, allowing early rehabilitation with stable coverage and maintained alignment.
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