Reconstruction of a massive tibial defect using trifocal bone transport and free flap: A case report

Cárdenas J.E.M. · World Journal of Orthopedics (2026) · DOI: 10.5312/wjo.v17.i4.114143

Resumen

BACKGROUND Segmental bone loss caused by an open fracture is a challenging entity to treat, particularly when it is complicated by an infection. Combining bone reconstruction and soft-tissue coverage is crucial for limb salvage. CASE SUMMARY A 30-year-old male with a history of open tibial shaft fractures complicated by infections presented with a segmental bone defect of 13 cm and a soft-tissue defect measuring 10 cm × 15 cm. The patient was treated with radical debridement, anterolateral thigh free flap coverage, and trifocal bone transport with a circular Ilizarov fixator. A secondary correction of a mechanical axis deformity and subsequent conversion to internal fixation were also performed. Six months after the frame removal, the patient resumed daily and work activities without pain or signs of infection. He achieved an excellent Association for the Study and Application of the Method of Ilizarov score. CONCLUSION Trifocal bone transport combined with free flap coverage was effective and safe for treating critical tibial defects caused by post-traumatic infection. This technique allowed limb preservation and avoided amputation. ©Author(s) 2026.