Tibia Bone Loss , Bone Graft issues

I am 32 year male and was involved in an accident on Dec 11th 2014 in Houston Texas, USA., with multiple fractures on fibula and tibia including ~4 cm bone loss at the bottom region the tibia , fracture on femur and left ring finger .I also have partial drop foot because of the muscle loss .Please refer the X-rays for fracture details.


The other major procedure is the free flap plastic surgery to my leg ( used muscles from back/ rib region and skin from thigh to cover up my leg) and also have only 1 artery alive on my left leg (only Posterior Tibial ). While the fractures are taken care by nail and plates, the bone loss was the concern from day 1. We had to choose between "ilizarov technique" and " bone graft " for the 4 cm bone loss on my left leg tibia resulting from open fracture and I choose the bone graft

My bone graft was done on Feb 11th 2015 . After 2.5 months now there was one small blood bubble wound which didn't heal and I was admitted again (on April 28th 2015) to check if there is any infection which they don't want to happen. They lifted the free flap and took cultures from my bone graft for testing infection . The results showed Positive for "Pseudomonas aeruginosa" bacteria. I am on a 6 week IV antibiotic " Cefepime" To tackle this infection. Apart from it the X-rays shows that the bone graft had not yet started healing and is in the same condition as placed 2.5 months back.


So the doctor feels that the bone graft would not work and I should soon go for ilizarov method for the nonunion to save my leg from amputation .They say for the ilizarov method it would take 13-30 months to heal depending on how much bone they need to trim.


But in my today's appointment (May 20th 2015) The X-ray shows some improvement. How significant is the improvement and if this is something positive and if my fracture would heal with the bone graft itself that's already done, without the need to go for ilizarov is something my doctor is not sure.


My queries if you can please help me would be ,

• Is it right with the doctor saying the bone graft done on me will not work? Should i go for ilizarov Technique immediately or is there any chances for the bone graft to heal with the antibiotics? ( i never had fever or puss formation, wound looks dry and clean now
• I kindly request you to let me know your expert opinion on how much bone needs to be removed which would eventually decide how long it will take to regrow and me be fit if we are going for Ilizarov technique.

• How long can i wait more and see of the bone graft heals? before i decide for Ilizarov.( this is the 3rd week of antibiotic and i have 3 more weeks to go)

Here are the latest X-Rays taken on May 8th uploaded in the below link.Old X-rays are also there in the sub folders (Accident day X-ray, X-rays Before bone graft and After bone graft)


Also uploaded initial surgery doctor reports for orthopedics and plastic surgery. (PDF files)


https://drive.google.com/<wbr>folderview?id=<wbr>0B6hB65ahAQkOcFpUUmZXczduN nM&<wbr>usp=sharing


Really appreciate your time and patience to go through this report. Would be very grateful for your expert advice.


Sincerely
Guru