A two-stage but time-saving reconstructive scheme to treat severe lower limb length discrepancy: Two case reports

Limb length discrepancy (LLD) is a common orthopedic condition that can result in significant functional impairment, pain, and cosmetic deformities. Current reconstructive techniques for severe LLD are primarily based on callus distraction, which is a time-consuming process that can lead to complications, such as significant infection, joint stiffness, and stress fractures. To reduce the therapeutic time and minimize the risk of complications, we investigated the use of vascularized bone flaps as a technical supplement to callus distraction in the reconstruction of short limbs. We present two cases of severe LLD in the upper and lower legs, in which a two-stage reconstruction approach was used. In the first stage, external fixation was applied to the affected limb to correct the soft tissue length and convert the short deformity into a bone defect. In the second stage, the bone defect was reconstructed using bilateral (patient A) or unilateral (patient B) free vascularized fibula bone grafts. Both patients had complete survival of the fibular grafts without stress fractures, and bone consolidation took 8 months (patient A) and 4 months (patient B). Compared to the traditional callus distraction, the two-stage approach was found to be more time-saving and reliable. The entire reconstructive scheme required 18 and 4 months for patients A and B, respectively, whereas the traditional callus distraction required 41 and 17 months, respectively. These findings suggest that the use of vascularized bone flaps as a technical supplement for callus distraction may provide an effective and efficient alternative for the treatment of severe LLD. Further studies are needed to validate these results and assess the long-term outcomes of this approach.