Acute shortening and lengthening following vascular repair with a vein graft for Gustilo–Anderson type IIIC open fracture: A report of two cases

We present two cases of lower extremity open fractures with vascular injury, where acute shortening and early lengthening were performed, following vascular repair with a vein graft. The two patients sustained Gustilo–Anderson type IIIC open fractures (one patient in the tibia and the other patient in the femur) with disruption of the popliteal artery. Initially, they were treated with debridement and stabilization using an external fixator. The disruptions of the popliteal artery were repaired by interposition of a saphenous vein graft. As soon as possible after the injury, the bone segment was resected and shortening was initiated with careful monitoring of blood circulation. After the bone gap and soft-tissue defects were closed at the end of the shortening, distraction osteogenesis was carried out in the proximal part of the tibia and the femur, respectively.There is not study reporting acute shortening and early lengthening performed on patients who underwent vascular repair with a vein graft. The procedures did not affect blood circulation, and resulted in a good clinical outcome. We consider this method a safe and effective way to treat lower extremity open fractures with vascular injury and massive soft tissue defects.