Outcomes of anterolateral thigh‐free flaps and conversion from external to internal fixation with bone grafting in gustilo type IIIB open tibial fractures

Abstract

The purpose of this study was to analyze the utility and the clinical outcomes of anterolateral thigh (ALT)-free flaps and conversion from external to internal fixation with plating and bone grafting in Gustilo type IIIB open tibial fractures. A total of 21 patients were analyzed retrospectively. The mean follow-up period was 18 months and the mean age was 46.7 years. There were 18 men and three women. The mean time from injury to flap coverage was 11.6 days. The mean size of flaps used was 15.3 × 8.2 cm. The mean size of bone defects was 2.26 cm. Segmental bone defects were observed in 5 five cases, for which bone transport or vascularized fibular graft were performed. When flaps were successful and the fracture sites did not have any evidence of infection, internal fixation with plates and bone grafting were performed. Flaps survived in 20 cases. In the 20 cases with successful flaps, two cases developed osteomyelitis, but the 20 cases achieved solid bone union at a mean of 8.6 months after the injury, salvaging the lower extremity in 100% of the cases. At the last follow-up, 9 nine cases were measured excellent or good; 6, fair; and 6, poor in the functional assessment based on the method developed by Puno et al. ALT- free flaps to cover soft tissue defects in Gustilo type IIIB open tibial fractures are considered as useful option for the treatment of composite defects. In addition, conversion to internal fixation and bone grafting can be an alternative method in order to reduce the risk of complications and inconvenience of external fixators.

Distally based saphenous neurocutaneous perforator flap combined with vac therapy for soft tissue reconstruction and hardware salvage in the lower extremities

“…The results in our series showed that, with the aid of the VAC therapy, the distally based saphenous neurocutaneous perforator flaps are able to cover the soft tissue defects with the exposed hardware in lower extremities. However, for patients with extensive defects, free flaps are still great tools and have traditionally been regarded as the first choice . A further study with a large number of patients is also required to assess the effectiveness and safety of this combined procedure.…”

“…However, for patients with extensive defects, free flaps are still great tools and have traditionally been regarded as the first choice. [39][40][41] A further study with a large number of patients is also required to assess the effectiveness and safety of this combined procedure.…”

Laser-Assisted Indocyanine Green Angiography Aids in the Reconstruction of Gustilo Grade IIIB Open Lower-Limb Fractures

“…Reconstruction within a few days after open lower-limb fractures with severe soft-tissue injuries has been reported to decrease the frequency of infection and pseudoarthrosis and to increase the rate of graft survival and flap success. [2][3][4][5] The most important prognostic factors after an open fracture are the site of the wounded area, the degree of soft-tissue injury, and the quantity of contamination. The Gustilo grade is the most commonly used classification method for open fractures.…”

Lower extremity soft tissue defect reconstruction with the serratus anterior flap

“…The disadvantages of the latissimus dorsi and rectus abdominis free flaps have resulted in the emergence of thinner perforator flaps, such as anterolateral thigh flaps, as an additional option for lower limb soft tissue reconstruction . However, variable outcomes have been reported following the use of perforator flaps with some studies having reported significantly higher complication rates for perforator flaps compared to conventional muscle flaps, particularly in the lower leg …”

“…The disadvantages of the latissimus dorsi and rectus abdominis free flaps have resulted in the emergence of thinner perforator flaps, such as anterolateral thigh flaps, as an additional option for lower limb soft tissue reconstruction. [6][7][8] However, variable outcomes have been reported following the use of perforator flaps with some studies having reported significantly higher complication rates for perforator flaps compared to conventional muscle flaps, particularly in the lower leg. [8][9][10][11] We present a case series of 18 patients who underwent reconstruction of lower limb soft tissue defects using serratus anterior muscle free flaps to demonstrate the reliability and versatility of this flap for lower extremity defect reconstruction of both acute and chronic wounds.…”