PMC6053650_01
(a, b) Anteroposterior and lateral radiographs of left tibia and fibula showing bridging plates with screws transfixing visible fractures of the distal tibia and fibula. There are mildly displaced butterfly fracture fragments of both bones. There is no radiographic evidence of bony bridging of the fracture fragments.
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F1
The preoperative radiographs are shown in Figure 1.
Arteriogram views of the supracondylar region (a, b) and the distal lower extremity (c, d) showing the widely patent common femoral, superficial femoral, and popliteal arteries. There is 3-vessel runoff to the foot via the widely patent anterior tibial, posterior tibial, and peroneal arteries.
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F2
Angiogram of his involved extremity demonstrated 3-vessel runoff (Fig 2).
(a, b) Fluoroscopic image and wound following first-stage debridement and antibiotic bead placement.
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F3
Postoperative radiographs and photographs after the first stage are shown in Figure 3.
Immediate postoperative view of the chimeric myo-osseous MFC flap (a), AP (b), and lateral (c) computed tomographic scans of the MFC flap (arrow) at 3 months postoperatively, AP (d) and lateral (e) plain radiographs of the flap at 9 months postoperatively showing good bone healing, and a final photograph of the healed flap at 9 months postoperatively (f). MFC indicates medial femoral condyle; AP, anteroposterior.
eplasty18e23_fig4.jpg
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F4
The muscle was advanced and placed over the chronic wound area above the periosteum of the bone component of the composite flap (Fig 4).