Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table, with the affected limb prepared and draped in a sterile fashion to allow access to both the anterior and posterior aspects of the leg.

Anatomical surgical approach:  A longitudinal incision was made over the medial aspect of the proximal tibia. The medial gastrocnemius muscle was identified and elevated with care to preserve its neurovascular supply. A skin island was included in the flap design to cover the soft tissue defect. The flap was transposed to cover the defect, and a provisional cement spacer was placed within the bone defect.

The surgeon noted that the medial gastrocnemius flap provided excellent coverage of the soft tissue defect. The provisional cement spacer was placed without difficulty, maintaining alignment and space for future bone transport. The subsequent stage involved the application of an Ilizarov external fixator for bone transport and lengthening.

Postoperative protocol:   Postoperatively, the patient was instructed to maintain non-weight bearing on the affected limb. Range of motion exercises for adjacent joints were initiated early to prevent stiffness. Gradual weight-bearing was introduced as tolerated following consolidation of the transported bone segment.

Follow up:   Not specified.

Orthopaedic implants used:   Ilizarov external fixator, provisional cement spacer, morphogenetic protein (for conversion from external to internal fixation).