[Functional reconstruction of the forearm by composite free flap of fibula and soleus reinnervated. About a clinical case]

Subject: We present the case of a forearm functional reconstruction of composite fibula free flap. This is a complex forearm trauma by crushing in a 24-year-old patient. The assessment of the lesions showed a bone defect of 15cm radial and ulnar diaphysis, a muscular defect of the posterior compartment of the forearm and a large skin defect next. The radial pedicle was also injured.

Methods: At 48hours, we conducted a reconstruction by free fibular flap and soleus muscle. The fibula osteosynthesys was performed between the proximal ulna and radius distally. The nerve of the soleus muscle was anastomosed to a branch of the posterior interosseous nerve and tendons of the extensor muscles of the wrist and fingers were sutured to the distal portion of the transferred muscle.

Results: At 6 months, bone healing is achieved. Soleus muscle contracts and the strength of the extensor muscles of the fingers and wrist has been listed 4. Joint amplitudes of -20°/75° for the wrist, complete for the long fingers and the elbow. The aftermath of the donor site is minimal.

Conclusion: Reconstruction by free fibular flap and reinnervated soleus muscle is often cited in the literature but few cases are described. It is for us, the best therapeutic solution for this type of injury. It restores muscle function satisfactorily all ensuring high quality coverage defect of the forearm.