Double Level Bone Transport for Severe Bone Loss

A 36 year old male sustained a high-energy Gustilo-Anderson Type IIIB open, comminuted tibia fracture and underwent serial irrigation and debridements resulting in an 18 cm tibial bone defect and significant soft tissue loss. The patient underwent soft tissue reconstruction with a gastrocnemius rotational flap and split-thickness skin grafting. The patient was then treated with a double-level tibial bone transport over the course of 18 months. The importance of determining the rate of regenerate consolidation, close follow-up, multidisciplinary collaboration, and patient compliance is discussed. Technical tricks for optimizing healthy regenerate growth and achieving docking site union are presented. The patient is full weightbearing and happy with his clinical outcome.