Single-stage Segmental Tibial Defect Reconstruction With Double-barrel Free Fibula Flap and Intramedullary Nail: An Innovative Technique Facilitating Early Load Bearing

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The authors present a novel approach using a vascularized double-barrel fibula flap combined with an intramedullary nail (IMN) to reconstruct critical-size segmental tibial defects. Current methods, such as bone transport or induced membrane techniques, require multiple procedures and are associated with high complication rates and delayed load bearing. We present the case of a 44-year-old man with nonunion and chronic osteomyelitis of the left tibia, who underwent reconstruction with a contralateral double strut free fibula flap, placement of IMN, and cancellous bone grafting. The patient had an uncomplicated postoperative course and achieved full weight-bearing in 4.5 months. This method provides a single-stage, effective reconstruction overcoming limitations of traditional techniques.