Experience of using local flaps to cover open lower limb injuries at an Indian trauma center

Abstract

Background:Optimal care of open, high-velocity, lower limb injury requires surgical skills in debridement, skeletal stabilization, and in providing appropriate soft tissue cover. Timely coordination between orthopedic and plastic surgeons, though ideal, is often difficult. In our center, orthopedic surgeons undertake comprehensive treatment of open fractures including soft tissue cover. We reviewed the results of the local flaps of lower limb, done by orthopedic surgeons.Materials and Methods:We retrospectively reviewed the results of the lower limb flaps done between January 2005 and December 2006. All flaps done at and below the level of knee were included.Results:There were 105 patients with 120 flaps during this period. Two patients with two flaps were lost to follow-up. The average age was 32 years. Sixty-four patients had Type IIIB Gustilo and Anderson injuries. Thirty-nine patients had isolated soft tissue injuries. The indications for flaps were exposed bone, tendon, and joint in 45, 11, and 12, respectively, or a combination in 35 patients. The flaps done were 51 reverse sural artery, 35 gastrocnemius, 25 local fasciocutaneous, and seven foot flaps. The flap dimensions ranged from 2 × 2 to 30 × 15 cm. Ninety-three flaps (79%) healed primarily. Among 25 flaps (21%) with necrosis, 14 flaps required secondary split skin graft for healing, while the other nine flaps healed without further surgery.Conclusion:Appropriate soft tissue cover provided by orthopedic surgeons can help in providing independent, composite care of lower limb injuries.

Flap Decisions and Options in Soft Tissue Coverage of the Lower Limb

“…Foot coverage has been successfully performed using sural artery-, lateral calcaneal artery based-, extensor digitorim brevis muscle rotation-, and abductor halluces muscle rotation- flaps [ 70 - 72 ]. Dorsalis pedis based flaps are also often considered in the foot [ 73 ].…”

Barriers to Performing Soft Tissue Reconstruction Procedures among Orthopedic Surgeons in Low- and Middle-income Countries: Results of a Surgical Skills Training Course

“…17,18 Training orthopedic surgeons in locations where plastic surgeons are not readily available may be an effective intervention for scaling patient access to soft tissue coverage procedures in LMICs. 11,19,20 The Surgical Management and Reconstructive Training (SMART) course curriculum is 1 such effort to train orthopedic surgeons from low-resource settings in managing soft tissue injuries and complex fractures by introducing the principles of ortho-plastic surgery and the reconstructive ladder to surgeons who must understand plastic surgery principles to address limb trauma. Course educators emphasize lower leg soft tissue coverage using gastrocnemius, soleus, and reverse sural flaps that can easily be performed without loupes, an operating microscope, or microvascular instruments.…”

The use of negative pressure therapy and hyaluronic acid for the management of post‐traumatic lower limb injury

“…Surgical treatment is always the first choice in lower limb trauma; it may be based on local flap, wherever peripheral tissues permit it. Sural artery flap could be performed for lower‐third leg reconstruction (5–7), but its effectiveness is often limited by the nature and the infection of the bed, as in this case (8). Gastrocnemius muscle flap is a safe and relatively simple flap.…”