Coverage of exposed bone and hardware of the medial malleolus with tibialis posterior artery perforator flap after ankle fracture surgery complications

Mb, Ozturk; Aksan, Tolga; Ertekin, Cengiz; Tezcan, Mustafa

doi:10.1111/iwj.13289

Cited by 8 publications

(7 citation statements)

References 29 publications

(63 reference statements)

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“…In this case, LIFCEF was chosen for the treatment considering the soft-tissue injury and the planned reconstruction of the soft tissue using RSAF. Soft-tissue defect around the ankle joint is challenging for soft-tissue reconstruction due to the limited amount of skin and subcutaneous tissue and the tendency for bones and tendons to be exposed [ 2 ]. Skin grafts cannot be used for exposed bones and tendons, and local flaps are unsuitable for reconstruction due to the lack of soft tissues and mobility.…”

Section: Discussionmentioning

confidence: 99%

“…These fractures are difficult to treat due to articular comminution and soft-tissue injuries caused by high-energy trauma [ 1 ]. In addition, reconstruction of the soft tissue around the ankle joint can be challenging due to the lack of soft tissue [ 2 ]. Open reduction and internal fixation (ORIF) is a commonly used method of treatment.…”

Section: Introductionmentioning

confidence: 99%

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A Case of Closed Pilon Fracture Resulting in Soft-Tissue Necrosis and Treated with Reverse Sural Artery Flap and Circular External Fixation

Igaki,

Yasuda,

Samejima

et al. 2023

Case Reports in Orthopedics

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Tibial pilon fractures are difficult to treat due to articular comminution and soft-tissue injuries caused by high-energy trauma. Open reduction and internal fixation is a commonly used method of treatment. However, it has a high risk of infection and soft-tissue complications due to the extensive detachment of soft tissue. We report on a case with a tibial pilon fracture and soft-tissue necrosis that we treated using limited internal fixation combined with a circular external fixator (LIFCEF) and reverse sural artery flap (RSAF) as part of an orthoplastic approach within the orthopedic surgery department alone, which obtained good results. A 51-year-old man was injured in a motorcycle accident and transported to a nearby hospital. X-rays at the time of injury showed tibial pilon fractures (AO Foundation/Orthopedic Trauma Association 43c3.3, Ruedi–Allgower: Type III). Soft-tissue necrosis with blisters on the medial side of the lower leg (AO soft-tissue classification: IC3-MT1-NV1) was observed. In addition, the patient was referred to our hospital on day 10 of the injury. LIFCEF was chosen for treating the fracture because plate fixation was accompanied by the risk of plate exposure, soft-tissue complications, and an increased skin defect area, and RSAF was chosen to reconstruct the soft tissue defect. Four years after the surgery, the American Orthopedic Foot and Ankle Score was 92 points. X-ray alignment evaluation showed mLDTA 93° and aADTA 91°. Stage 2 arthrosis was present according to the Takakura ankle osteoarthritis classification, but the patient was able to walk without pain. Tibial pilon fractures are difficult to treat due to articular comminution and soft-tissue injuries caused by high-energy trauma. The timing and choice of treatment are crucial concerning the soft tissue.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Case of Closed Pilon Fracture Resulting in Soft-Tissue Necrosis and Treated with Reverse Sural Artery Flap and Circular External Fixation

Igaki,

Yasuda,

Samejima

et al. 2023

Case Reports in Orthopedics

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“…In recent years, the posterior tibial artery medial supramalleolar perforator flap has been widely applied in clinical repair, which effectively solves the problem of soft tissue defect of dorsum of foot and ankle. 21,22 Therefore, this study used the posterior tibial artery perforator technique combined with iliac crest autograft to repair the medial soft tissue and medial malleolus loss. However, in most countries with bone banks, allogeneic bone grafts are used to treat the medial malleolus loss.…”

Section: Discussionmentioning

confidence: 99%

Medial Soft tissue and medial malleolus loss-the posterior tibial artery perforator technique combined with iliac crest autograft to Stabilize the ankle and cover Soft tissue defect: A case Series

Yan

Xie

et al. 2022

J Orthop Surg (Hong Kong)

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Purpose The purpose of this study was to investigate clinical efficacy of posterior tibial artery perforator technique combined with iliac crest autograft in treatment of medial soft tissue and medial malleolus loss. Methods This study involved 11 cases of medial soft tissue and medial malleolus loss from October 2011 to March 2016. Patients were treated with posterior tibial artery perforator technique combined with iliac crest autograft, and given routine treatment, such as rehydration, anti-inflammation, anticoagulation and vasodilation. Ankle function of patients was evaluated according to the American Orthopedic foot and ankle Association (AOFAS) ankle-hind foot scoring system. Results All flaps survived without bone exposure, and the appearance of skin flaps was satisfactory. There was one case of arterial crisis, one case of venous crisis, one case of skin edge necrosis and one case of incision infection. Wounds of the above patients were healed. Skin flap was soft and elastic without secondary contracture. The two-point discrimination of skin flap was 5–11 mm. The ankle range of motion was 10–60°. X-Ray showed that grafts healed within 8.6 months. According to AOFAS evaluation, four cases were excellent, four cases were good, and three cases were poor. The excellent and good rate was 72.8%. Conclusions In this study, posterior tibial artery perforator technique combined with iliac crest autograft was used to treat medial soft tissue and medial malleolus loss. The findings demonstrated that this treatment was reliable and efficacious.

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“…The severe wound complications associated with an extramedullary implant due to the compromised blood supply (arterial occlusion diseases, diabetes, and postthrombotic sequels) and the thin soft tissue envelope require removal of the plate (with secondary stability impairment) and additional challenging reconstructive technical solutions including split-thickness skin grafts and local or locoregional flaps [27][28][29]. With regard to the use of split-thickness skin grafts, they are often impossible to use in the case of soft part defects in the ankle, due to bone or tendinous exposure.…”

Section: Locked Intramedullary Xs Nail For Ankle and Pilon Fractures:mentioning

confidence: 99%

Clinical and Experimental Biomechanical Studies Regarding Innovative Implants in Traumatology

Sîrbu¹,

Friedl²,

Mihăilescu³

et al. 2020

Recent Advances in Biomechanics

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Fracture treatment has experienced a fascinating evolution in the last years. The aim of this chapter is to reveal some clinical and biomechanical studies regarding innovative implants. After a short introduction (1), we intend to present our results regarding (2) dynamic condylar screw versus condylar blade plate in complex supracondylar femoral fractures; (3) biomechanical analysis of four types of implants in humeral fractures; (4) clinical and experimental studies for optimal stabilization of trochanteric fractures: the gliding nail; (5) intramedullary XS nail for pilon and ankle fractures: design, biomechanics, and clinical results; (6) the XS nail for the treatment of patella and olecranon fractures; and (7) plates with polyaxial stability for fractures of distal radius and proximal humerus. In conclusion, the authors highlight the advantages of these innovative implants in difficult trauma cases. Biomechanics 2 DCS versus CBP in complex supracondylar femoral fractures: a biomechanical studyDistal femoral fractures represent a challenge for orthopedic surgeons, and despite numerous biomechanical studies, the optimal implant is still controversial [1][2][3][4]. However, while plates with angular stability and retrograde interlocking nails are nowadays the best choice for treatment, CBP and DCS were the most used implants until the development of these innovative implants [5].In a biomechanical study from 2009, the authors compared the mechanical rigidity of the bone/implant (DCS or CBP) construct in complex supracondylar femoral fractures [5,6].Twelve synthetic composite femoral bones were fixed in the distal part with six DCS and six CBP, and then, the authors performed by osteotomy a bone defect of 1.5 cm to simulate a complex supracondylar fracture type A3/AO (Figure 1).The femurs were sectioned in the midshaft, and the proximal part of the distal fragments was fixed in a metallic adapter sleeve. The bone-implant constructs were tested for seven types of loading: (1) internal compression; (2) external compression; (3) anterior compression; (4) posterior compression; (5) axial compression; (6) external torsion; and (7) internal torsion.The compression tests were realized up to 350 N, and the applied torsion attended 25 Nm. The tests were repeated six times in order to establish the statistic dispersion. All the measurements for DCS were realized with or without compaction screw.The compression force and loading force were measured by a M221B04 (PCB Piezotronics force transducer), while linear deformation values for the compression were measured using two inductive transducers applied in frontal axis (TD1) and sagittal axis (TD2) (Figure 2). Data acquisition was realized by a six-channel admittance bridge, an interface board, and a digital data acquisition system DAQ1200 connected to a laptop.According to study measurements, by reporting the loading/unloading force to the transducer (TD1 and TD2) displacement, we represented hysteresis cycles as diagrams for the femur/DCS (with and without compaction screw)...

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Coverage of exposed bone and hardware of the medial malleolus with tibialis posterior artery perforator flap after ankle fracture surgery complications

Cited by 8 publications

References 29 publications

A Case of Closed Pilon Fracture Resulting in Soft-Tissue Necrosis and Treated with Reverse Sural Artery Flap and Circular External Fixation

A Case of Closed Pilon Fracture Resulting in Soft-Tissue Necrosis and Treated with Reverse Sural Artery Flap and Circular External Fixation

Medial Soft tissue and medial malleolus loss-the posterior tibial artery perforator technique combined with iliac crest autograft to Stabilize the ankle and cover Soft tissue defect: A case Series

Clinical and Experimental Biomechanical Studies Regarding Innovative Implants in Traumatology

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