BACKGROUND In a high conflict region, war injuries to the distal lower extremity are a major source of large composite defects involving bone and soft tissues. These defects are at the edge between using a single free flap [osteo-(+/-myo) cutaneous] vs double free flap reconstruction (bone and soft tissue). In this paper, we present our experience and outcomes in treating patients with leg war injury reconstructed using a single free fibula flap. METHODS Fifteen patients with distal leg composite defects secondary to war injuries were treated between January 2015 and March 2016. All patients were reconstructed using single barrel free fibula osteo-(+/-myo)cutaneous flap where single or double skin paddles were used according to the soft tissue defect requiring coverage. RESULTS There were no cases of total or partial flap loss. Complications were limited to three cases including traumatic fibula fracture, venous congestion with negative findings, and residual soft tissue defect requiring coverage. There were no cases of wound dehiscence or infection. Mean follow-up time was 418.8 days. Mean bone healing time was nine months after which patients were allowed full weight bearing. CONCLUSION A single barrel free fibula osteo-(+/-myo)cutaneous flap is a valid and reliable tool for reconstruction composite lower extremity defects post-war injury. Adequate planning of fibula flap soft tissue components (skin, muscle) rearrangement is essential for success in such challenging reconstructions.

中文翻译：

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战后复合腿部缺损的重建。

背景技术在高冲突区域中，下肢远端的战伤是涉及骨骼和软组织的大的复合缺陷的主要来源。这些缺陷位于使用单个游离皮瓣[骨-（+/- myo）皮肤]与两次游离皮瓣重建（骨和软组织）之间的边缘。在本文中，我们介绍了使用单个游离腓骨皮瓣重建的腿部战争伤患者的治疗经验和结果。方法2015年1月至2016年3月，共收治15例因战伤继发远端腿部复合缺损的患者。所有患者均采用单桶游离腓骨骨-（+ / yoyo）皮瓣重建，并根据情况使用单或双皮桨需要覆盖的软组织缺损。结果没有完全或部分皮瓣丢失的病例。并发症限于三例，包括腓骨外伤骨折，静脉充血，阴性结果以及需要覆盖的残余软组织缺损。没有伤口裂开或感染的情况。平均随访时间为418.8天。平均骨愈合时间为9个月，此后允许患者负重。结论单桶游离腓骨骨（+/- myo）皮瓣是战后损伤后下肢复合缺损重建的有效和可靠工具。腓骨瓣软组织成分（皮肤，肌肉）重排的充分计划对于成功进行如此具有挑战性的重建至关重要。没有伤口裂开或感染的情况。平均随访时间为418.8天。平均骨愈合时间为9个月，此后允许患者负重。结论单桶游离腓骨骨（+/- myo）皮瓣是战后损伤后下肢复合缺损重建的有效和可靠工具。腓骨瓣软组织成分（皮肤，肌肉）重排的充分计划对于成功进行如此具有挑战性的重建至关重要。没有伤口裂开或感染的情况。平均随访时间为418.8天。平均骨愈合时间为9个月，此后允许患者负重。结论单桶游离腓骨骨（+/- myo）皮瓣是战后损伤后下肢复合缺损重建的有效和可靠工具。腓骨瓣软组织成分（皮肤，肌肉）重排的充分计划对于成功进行如此具有挑战性的重建至关重要。