Limb lengthening by callus distraction and external fixation has a high rate of complications. We describe our experience using an intramedullary nail (Fitbone) which contains a motorised and programmable sliding mechanism for limb lengthening and bone transport. Between 2001 and 2004 we lengthened 13 femora and 11 tibiae in ten patients (seven men and three women) with a mean age of 32 years (21 to 47) using this nail. The indications for operation were short stature in six patients and developmental or acquired disorders in the rest.

The mean lengthening achieved was 40 mm (27 to 60). The mean length of stay in hospital was seven days (5 to 9). The mean healing index was 35 days/cm (18.8 to 70.9). There were no cases of implant-related infection or malunion.

We evaluated the effectiveness of local and free flap cover done at revision surgery for infected endoprosthetic replacement (EPR) in achieving ultimate control of infection.

Methods: Ten patients needed plastic surgical input in the form of flap cover at the time of revision surgery for infective endoprosthetic failure between March 1999 and March 2005. The revision of EPR itself was undertaken in 2 stages. The 1st stage involved removal of the endoprosthesis, insertion of antibiotic spacer and flap cover. After achieving adequate control of infection, 2nd stage revision was carried out, in which the spacer was exchanged for an endoprosthesis.

Results: Average age at time of flap surgery was 29 years (range 14 – 58 years). Average follow up was 23 months (3 to 72 months) for patients who remained free of infection and 19 months (5 to 52 months) for those who underwent amputation. 9 out of 10 patients underwent some form of muscle flap (6 free LD flaps, 2 gastrocnemius flaps and 1 pedicled LD flap). Infection was adequately controlled in 5 out of 6 patients in free flap group. Out of 4 patients who underwent local flaps, 2 ended up having amputation.

Conclusion: Reconstructive surgery in the form of flap cover has an important role in limb salvage in patients with endoprosthetic failure due to infection. The aim of such surgery should be to provide as much new vascularized tissue over the dependent portions with sinuses and areas of radiotherapy with scarring. Results of cover by a broad flat musculocutaneous flaps seem to be better in comparison to local flaps.