Flaps in the management of open tibial fractures
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20191792Keywords:
Open fractures, Tibia, Flap coverAbstract
Background: The prognosis in open fractures is primarily determined by the amount of soft tissue loss and the level of contamination. Severe open tibial fractures usually require combined orthoplastic approach in the management. Our aim is to study the effectiveness of soft tissue flaps in the management of type III B open tibial fractures.
Methods: The study material consists of 20 cases of grade III B open tibial fractures admitted in our institution. Under anaesthesia, wound debridement was done and fracture stabilised with external fixator or IM nail depending upon the wound status. Patient underwent flap cover once the wound was fit. Periodic follow up was done.
Results: Nonunion occurred in one patient (5%). Chronic osteomyelitis developed in two patients (10%). Deep infection occurred in three cases (15%). There was no secondary amputation in our series. The average union time of fracture was 30.1 weeks. Lower third fractures and those patients with extensive soft tissue injury, delayed flap cover and flap failure had longer union time.
Conclusions: Fasciocutaneous flap has definitive role in the management of type III B open tibial fractures with soft tissue loss.
Metrics
References
Anderson JT. History of treatment of open fractures in Gustilo. 4th ed., Philadelphia, W.B. Saunders; 1982: 1-11.
Terry Canale S, Beaty JH. Campbell's Operative Orthopaedics. 12th ed. Mosby- year book. Missouri; 2013
Barclay TL, Cordosa E. Repair of lower leg injuries with fasciocutaneous flap. British J Plastic Surg. 1982;35:125-32.
Barclay TL, Sharpe DT. Cross leg fasciocutaneous flap. Plastic Reconstruc Surg. 1983;72:843-6.
Burkhalter WE. Open injuries of the lower extremities. Surg Clin North Am. 1973;53:1439-57.
Caudle RJ, Stern PJ. Severe open fractures of the tibia. J Bone Joint Surg. 1987;69A:801-7.
Chapman MW. The role of intramedullary fixation in open fractures. Clin Orthopaedic. 1984;212:26-34.
McCarty's Plastic Surgery. Reconstruction of the lower extremity, volume 6.W.B.Saunders, 1990.
Fischer MD, Gustilo RB, Verecka TF. The timing of flap coverage, bone grafting and IM nailing in patients with tibial shaft fractures with extensive soft tissue injury. J Bone Joint Surg Am. 1991;73(9):1316-22.
Cole JD, Ansel LJ, Schwartzberg R. A sequential Protocol for Management of severe open tibial fractures. Clin Orthop. 1995;315:84-103.
Wiss DA, Sherman R, Oechsel M. External skeletal fixation and rectus abdominis free flap in the management of severe open fractures of the Tibia. Orthop Clin North Am. 1993;24(3):549-56.
Moda SK, Kalra GS, Gupta RS, Maggu NK. The role of early flap coverage in the management of open fractures of both bones of the leg. Injury. 1994;25(2):83-5.
Downloads
Published
How to Cite
Issue
Section
