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Long segment bone loss

What is long segment bone loss?

Absence of bone in of length more than 3 cm is called long segment bone loss. Loss of less than 3 cm can actually be treated by just shortening the leg and making the bone ends meet. However, for longer lengths this cannot be done and more complex reconstruction is necessary.

When does this occur?

Long segment bone loss is seen with open fractures or infection. In open fractures, bone pieces may be actually lost at site of injury or they may be removed at surgery if they are found to be without blood supply. Similarly in infections, the bone may have to be removed for control.

How can it be treated?

There are two major techniques of treating long segment bone loss – distraction osteogenesis and free fibula flap. Distraction osteogenesis is the slow stretching of bone, while the gap gradually fills with bone. The free fibular flap transfers a bone in to the gap along with its blood supply.

What role does Plastic Surgery play?

The free fibular flap requires harvesting of the thin bone from the leg with its blood vessels. This bone piece is transferred to the gap and blood vessels connected under the microscope. Such surgery is performed by Plastic surgeons trained in Microsurgery.

How long does this take?

The transferred fibula takes about 3 months to fuse the gap. Till then walking on that leg is not possible. However other leg exercises can be begun as early as one month.

What happens to the leg from which bone is taken?

The fibula is the thin bone in the leg and is not weight bearing in function. So taking it out does not cause any long term problems with walking. The ends of the bone near the knee and ankle joints are not taken to preserve joint stability.

Xray showing long segment loss in the femur bone near knee

Intra operative pictures of the free fibular flap with the allograft.

Intra operative pictures of the free fibular flap with the allograft.

Inset of flap and allograft in to the bone defect.

After wound healing

Xray showing filled up gap in the bone.