Simultaneous internal fixation and soft tissue coverage by soleus muscle flap and variances: a reproducible strategy for
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ORIGINAL ARTICLE
Simultaneous internal fixation and soft tissue coverage by soleus muscle flap and variances: a reproducible strategy for managing open fractures of tibial shaft Surasak Jitprapaikulsarn1 · Chawanan Patamamongkonchai1 · Arthit Gromprasit1 · Witoon Thremthakanpon1 Received: 26 June 2020 / Accepted: 1 September 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Background The role of internal fixation and local muscle flaps for open tibial fractures is still not specifically determined. We describe the integration of internal fixation and soleus muscle flap for open fractures complicated with soft tissue loss of the tibial shaft. Methods Twenty-seven patients with Gustilo IIIB open fractures of the tibial shaft were operated on by internal fixation and soft tissue coverage by soleus muscle flaps and variances. Data were collected on types of implants, types of flaps, union time, postoperative complications, and objective clinical measurement. Results Regarding implants for fixation, plates and screws were selected in 22 patients, and intramedullary nails in 5. Proximally based soleus flap was used in 17 patients, hemisoleus in 6, and reversed hemisoleus in 4. All flaps survived and all fractures were united with a mean union time of 21.8 weeks (range 14–30). One patient had unplanned reoperations due to delayed union and equinus deformity of the ankle. All patients had good-to-excellent Puno functional score results. Conclusion Internal fixation and soft tissue coverage, frequently referred to as ’fix and flap’, by a local soleus muscle flap is safe and effective for open fractures accompanied with small-to-medium size soft tissue defect of the tibial shaft. Keywords Fix and flap · Soleus muscle flap · Open fracture of tibial shaft
Introduction Open fractures complicated with soft tissue loss which are classified as Gustilo type IIIB present a challenging task in orthopedic practice [1]. Owing to the particular anatomy of the tibial shaft, it has the propensity to acquire concurrent bone and soft tissue injuries from substantial trauma and consequently end up with several complications such as infection, nonunion and irretrievable limb function and survival [2]. Thus, for establishing adequate outcomes, delicate coordination of fracture stabilization and soft tissue reconstruction plays a crucial role in the management of this particular injury. Various treatment regimens of Gustilo type IIIB open tibial fractures have been reported in the literature. Soft * Surasak Jitprapaikulsarn [email protected] 1
Department of Orthopedics, Buddhachinaraj Hospital, 90 Srithamtraipidok Road, Phitsanulok 65000, Thailand
tissue reconstruction and definitive external fixation tend to be complicated with adverse consequences including pin tract infection, nonunion, and malunion [3–5]. In a protocol of delayed conversion of external to internal fixation after complete wound healing, the awkwardness of the external device and complications from prolonged external fixation rema
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