Miranda Cárdenas JE. Reconstruction of a massive tibial defect using trifocal bone transport and free flap: A case report. World J Orthop 2026; 17(4): 114143 [DOI: 10.5312/wjo.v17.i4.114143]
Corresponding Author of This Article
Jose Eduardo Miranda Cárdenas, MD, Principal Investigator, Department of Orthopedics and Traumatology, Hospital Guillermo Almenara Irigoyen, Lima 15033, Lima, Peru. josemiranda2909@gmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Apr 18, 2026 (publication date) through Apr 16, 2026
Times Cited of This Article
Times Cited (0)
Journal Information of This Article
Publication Name
World Journal of Orthopedics
ISSN
2218-5836
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Miranda Cárdenas JE. Reconstruction of a massive tibial defect using trifocal bone transport and free flap: A case report. World J Orthop 2026; 17(4): 114143 [DOI: 10.5312/wjo.v17.i4.114143]
World J Orthop. Apr 18, 2026; 17(4): 114143 Published online Apr 18, 2026. doi: 10.5312/wjo.v17.i4.114143
Reconstruction of a massive tibial defect using trifocal bone transport and free flap: A case report
Jose Eduardo Miranda Cárdenas
Jose Eduardo Miranda Cárdenas, Department of Orthopedics and Traumatology, Hospital Guillermo Almenara Irigoyen, Lima 15033, Lima, Peru
Author contributions: Miranda Cárdenas JE designed the study, performed the surgery, collected the data, and wrote the manuscript; the author has read and approved the final version of the manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and accompanying images.
Conflict-of-interest statement: The author declares no conflicts of interest related to this case report.
CARE Checklist (2016) statement: The author has read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Jose Eduardo Miranda Cárdenas, MD, Principal Investigator, Department of Orthopedics and Traumatology, Hospital Guillermo Almenara Irigoyen, Lima 15033, Lima, Peru. josemiranda2909@gmail.com
Received: September 12, 2025 Revised: October 20, 2025 Accepted: January 13, 2026 Published online: April 18, 2026 Processing time: 210 Days and 10.3 Hours
Abstract
BACKGROUND
Segmental bone loss caused by an open fracture is a challenging entity to treat, particularly when it is complicated by an infection. Combining bone reconstruction and soft-tissue coverage is crucial for limb salvage.
CASE SUMMARY
A 30-year-old male with a history of open tibial shaft fractures complicated by infections presented with a segmental bone defect of 13 cm and a soft-tissue defect measuring 10 cm × 15 cm. The patient was treated with radical debridement, anterolateral thigh free flap coverage, and trifocal bone transport with a circular Ilizarov fixator. A secondary correction of a mechanical axis deformity and subsequent conversion to internal fixation were also performed. Six months after the frame removal, the patient resumed daily and work activities without pain or signs of infection. He achieved an excellent Association for the Study and Application of the Method of Ilizarov score.
CONCLUSION
Trifocal bone transport combined with free flap coverage was effective and safe for treating critical tibial defects caused by post-traumatic infection. This technique allowed limb preservation and avoided amputation.
Core Tip: This case highlighted the successful treatment of a 13 cm tibial defect complicated by infections with trifocal bone transport combined with free flap coverage. The combined strategy allowed both soft-tissue coverage and skeletal restoration, and the patient avoided amputation. The management of this case emphasized the importance of multidisciplinary collaboration and sequential fixation to achieve excellent functional outcomes.
