Sequential Orthoplastic Reconstruction of a Massive 15-cm Posttraumatic Tibial Defect Using a Latissimus Dorsi Free Flap and Ilizarov Monofocal Bone Transport With the Fracture Segment – A Rare Case Report

Abstract

High-energy Gustilo–Anderson Grade IIIB open tibial fractures with massive segmental bone loss (>10 cm) present a major reconstructive challenge. We report a 49-year-old female with a 15 cm tibial defect and extensive soft tissue loss. A sequential orthoplastic approach was utilized. Initial debridement and spanning fixation were followed by a robust, large-volume latissimus dorsi (LD) free flap for definitive soft tissue coverage. Six weeks later, a mono-focal Ilizarov bone transport was initiated. The stable LD flap permitted safe pin placement and distraction. The transport successfully bridged the 15 cm defect, achieving full consolidation at 18 months. This staged strategy – prioritizing stable free flap coverage before delayed ilizarov bone transport – is a highly effective limb salvage alternative for massive defects, resulting in a high likelihood of union with excellent functional outcome and amputation avoidance.