Reconstruction of a tibial defect with a previously fractured fibula including the fractured segment as a free osteoseptocutaneous flap.

Introduction: Reconstruction of major bone defects using free fibular transfer provides a good biological option in unsound situations. Most authors recommend selection of the recipient blood vessels outside the zone of injury to achieve successful free fibular transfer. Occasionally, in polytraumatized patients, the surgeon has to use a previously fractured fibula as a graft, with increased risk of inclusion of the injury zone that may lead to failure.

Methods: We report a rare case of successful reconstruction of a large tibial defect using a previously fractured fibula as a free osteoseptocutaneous flap. The innovative point in our case is the inclusion of the fracture site within the utilized segment, which to our knowledge has never been reported.

Conclusions: As long as the microsurgical principles are adhered to, the effect of the zone of injury on the graft viability should not be overwhelming.