Female 25 year .. 4 months ago and because of bomb .. open tibial fracture gustilo IIIc with anterior and posterior tibial artery ruptures ..and with 10cm bone defect and muscular crush … deep fibular nerve was intact …. we decided limb salvage …. external fixator has been done and I have  repaired anterior tibial artery ….. for covering of bone and skin defects we have transfered of posterior musular into defect ….after 2 months the patient had second operation to cover defect with skin graft …after 4 months the skin graft has been healed and the patient had no infection CRP 3 and ESR 10 ….because of major defect of tibia the final operation is local vasularized fibular graft …

Photos of patient’s leg and its X -rays

 

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Skin incision

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Expose of bone edges and defect .201510070606371254744

Debridement of bone edges .

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Expose of fibula from same incision and dissect it extraperiosteally …. cut it and expose of fibular artery and vein that connect to fibular graft .

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transfer of vasularized fibular graft to debrided tibial edges and impact it in tibial bone canals .

 

Stabilize tibial fracture and vascularized fibular graft with dcp plate

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Tricortical iliac graft also to full residual small defects .

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Cancellous iliac graft

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Cancellous iliac graft in its place

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Control X-rays after surgery .

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