Page 50 SA Orthopaedic Journal Summer 2013 | Vol 12 • No 4 Open tibial bone transport following a failed bi-Masquelet procedure – a case report N Ferreira, BSc, MBChB, HDip Orth(SA), FC Orth(SA), MMed(Orth) LC Marais MBChB, FCS(Orth)(SA), MMed(Orth), CIME Tumour, Sepsis and Reconstruction Unit, Department of Orthopaedic Surgery, Grey’s Hospital, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa Correspondence: Dr N Ferreira Department of Orthopaedic Surgery Grey’s Hospital Private Bag X9001 Pietermaritzburg 3201 Email: drferreiran@gmail.com Tel: +27 33 897 3299 Fax: +27 33 897 3409 Background Managing large bone defects can be challenging for any orthopaedic surgeon. 1-5 Achieving satisfactory anatomical and functional results places increased demands on both the patient and surgeon, and requires a significant investment in terms of resources and time. 4,6,7 Most recon- structive techniques involve soft tissue reconstruction during the initial phase, which is then followed by bony reconstruction. 1,8 This sequence of events is not always possible as extensive soft tissue damage may preclude local flaps and patent donor vessels are required for free flaps. We report a case of successful open bone transport following a failed bi-Masquelet procedure. Soft tissue and bony reconstruction was achieved simultaneously with the use of a circular external fixator and distraction histo- genesis. Case report A 25-year-old man was referred to our tertiary level limb reconstruction unit after a failed bi-Masquelet procedure at a referring hospital/institution. He had sustained a severe open tibia fracture (Gustilo-Anderson IIIB) with circumferential soft tissue loss one year prior to presen- tation. 9-11 His initial management included multiple debridements and monolateral external fixation. The bi- Masquelet procedure was undertaken to reconstruct an infected non-union of the left tibia. At presentation to our unit the extensively scarred soft tissue overlying the cement spacer had broken down and the wound was infected (Figure 1). Abstract Large bone defects are challenging to reconstruct and require specialised techniques, multiple surgeries, and long treatment periods. When these bony defects are associated with large soft tissue defects, it complicates the management further, necessitating soft tissue reconstruction in the form of local or free flaps. We report a case of a 25-year-old male, where a failed bi-Masquelet procedure resulted in a large bone and soft tissue defect of the tibia. Local or free flap reconstruction was not possible due to the extensive scarring and lack of vascular donor vessels. Open bone transport, using distraction histogenesis, was successful in reconstructing both the bone and soft tissue defects. Key words: bone transport, bi-Masquelet, Ilizarov, bone defect, reconstruction Soft tissue and bony reconstruction was achieved simultaneously