Use of the vascular pedicle of a previously transferred muscle as the recipient vessel for a subsequent vascularized bone flap

In six complex lower extremely defects, we have been able to reconstruct combined bone and soft-tissue defects with primary free-muscle transfer, followed by secondary free vascularized bone transfer. Indications for this technique are long segmental bone defects of the tibia associated with large soft-tissue defects, which are not suitable for one-stage composite bone and soft tissue transfer. In the first stage of reconstruction, a well- vascularized muscle flap is used to obliterate the soft-tissue defect to prevent infection. At the second stage, a fibula osteocutaneous flap from the contralateral leg is used to complete the reconstruction. The vascular pedicle of the first muscle flap surrounded by fibrofatty cuff, serves as the recipient vessels free of scar at the time of the second vascularized bone transfer. This method provides great advantages in two-stage free-flap reconstruction of complicated cases in which localization of suitable recipient vessel is technically difficult.