Use of Single or Double Local Muscle Flap Transfers for Coverage of Tibia Bone Exposure

  • Thu, 9/4/08 - 11:52am
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Author(s): 
Kuo-Chin Huang, MD1 and Kuo-Chung Huang, PhD2

One challenge in wound care is to effectively manage soft-tissue defects in the lower extremities, which usually coexist with Gustilo type IIIB open tibial fractures and full-thickness necrotizing fasciitis.1 In an attempt to salvage these open complex leg lesions, appropriate soft-tissue reconstruction is typically required to reduce the risk of bone infection and to increase the survival of exposed vital structures, thereby preventing limb amputation.2–4 Since the late 1980s, numerous medical centers started successfully reconstructing the majority of traumatized lower extremities using microvascular free-tissue transfers.1,2 Thus, it is now widely accepted that open complex leg injuries require combined specialized orthopedic and plastic surgical treatment.5–7

However, most patients who arrive at regional hospitals with open complex leg injuries do not have access to combined orthopedic and plastic surgical services.7 Microvascular free tissue transfer is technically demanding work and has a steep learning curve. Most orthopedic surgeons do not have extensive microsurgical training and would hesitate to manage a patient with open complex leg injuries without plastic surgery support. Inter-hospital transfer typically results in a delay in applying definitive surgical treatment and can deleteriously affect the final clinical outcome.8–10 Therefore, the use of uncomplicated reconstructive methods, such as local muscle flap transfer by the front-line orthopedic surgeon, may be an appropriate solution. The present study evaluates the feasibility of applying local muscle flaps in managing patients who present with massive tibia bone exposure due to Gustilo type IIIB open fractures and full-thickness necrotizing fasciitis.

References: 

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