Floating the Flap: Suspension of Soft Tissue Free Flap Over External Fixation-Guided Bone Transport: A Novel Technique.

Methods: Wide resection of a synovial sarcoma of the anteromedial distal leg involving the dimetaphyseal tibia and posterior tibial tendon produced an 8.5-cm osseous defect. To keep the free flap from invaginating into the defect and prevent kinking of the anastomosis, six 1.5-mm Ilizarov wires (held in place by the external fixator) were placed under the flap to suspend it over the defect. No problems resulted with the vascularity or healing of the flap or with consolidation of the defect.

Conclusions: Suspending the flap over the defect with Ilizarov wires can prevent tissue invagination while avoiding need for additional procedures.