Background The cross-bridge free flap technique has been described for salvage of cases of traumatic lower limb defects when adequate recipient vessels in the same limb are lacking. While previous accounts mainly focused on utilizing muscle, myocutaneous, or perforator skin flaps, this study presents a series of cross-bridge free vascularized fibular transfer for reconstruction of traumatic tibial defects with extensive soft tissue loss.

Methods The study included 22 cases with an average age at surgery of 24 ± 8 years and an average tibial bone defect of 14.2 ± 3.3 cm. In this technique, the fibula was inset into the tibial defect and vascularization was performed using the posterior tibial artery of the contralateral leg through a radial forearm flap. The two legs were coimmobilized using Hoffmann external fixator and subsequently separated after 6 weeks.