Free vascularized tibial bone and nerve transfer: A spare-part reconstruction strategy for multiple extremity injuries

We describe a novel reconstructive approach using a free vascularized tibial bone transfer with skin and tibial nerve components to salvage a complex upper extremity injury in the setting of a non-salvageable lower limb. This technique was applied in a patient who presented with severe blast injuries to the left upper arm and to the right upper and lower leg. Injuries of the right lower leg were so severe that reconstruction was deemed surgically not feasible. The harvested composite free flap included tibia, posterior tibial artery, tibial nerve and a skin paddle based on the posterior tibial artery. This "spare-part" salvage surgery repurposes otherwise discarded autologous tissue to restore skeletal and neural integrity at a different anatomical site. This technique broadens the reconstructive options available in orthoplastic trauma care, particularly for polytrauma patients, such as those with extremity war injuries, where multiple limbs are severely affected. We propose this flap as a potential alternative in cases where a below-knee amputation is indicated and a large, vascularized bone or composite graft is required at a separate anatomical site.