School of Medicine

Department of Orthopaedics

How Committed Are You? Respecting the Choice of Limb Reconstruction

“How committed are you to this guy’s foot?”

This was the question my plastic surgery colleague asked me one evening over the phone after seeing a gentleman in clinic whom I had referred. The patient was a young man undergoing trifocal tandem bone transport for a segmental tibia defect lost to an infected non-union. He was in his sixth month of circular frame time and had no evidence of recurrent infection. His foot and ankle were vascularized, sensate, and supple. We had visited every two weeks to monitor regenerates and check wire sites. He had a single pin-site infection. The question posed in my referral pertained to options for a bulbous, old free flap that commonly caused skin irritation along one overhanging border. The result of all that was a question about my level of commitment toward this patient’s foot.

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