Jitprapaikulsarn S, Sukha K, Patamamongkonchai C, Gromprasit A, Thremthakanpon W. Utilizing the various forms of the gastrocnemius muscle in fix & flap protocol: a reliable remedy for open proximal tibial fractures with accompanying soft tissue defect.
Eur J Orthop Surg Traumatol 2021;
32:505-513. [PMID:
34021790 DOI:
10.1007/s00590-021-03013-0]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND
Open proximal tibial fractures accompanied by soft tissue loss are substantially challenging to accomplish both bony consolidation and wound healing. The authors retrospectively delineated the utility of the various forms of the gastrocnemius muscle in fix & flap regimen for management of such complicated injuries.
METHODS
Thirty-one patients with open fracture accompanied by soft tissue loss of proximal tibia were managed by the protocol of fix & gastrocnemius flap. The collected data included implant for fixation, form of the gastrocnemius flap, postoperative complications, union time, and clinical assessment.
RESULTS
According to fixation devices, lateral anatomical locking compression plates were selected in 28 cases, dual plates in 1, and interlocking nails in 2. According to the forms of the gastrocnemius flap, medial gastrocnemius flap was utilized in 22 cases, medial hemigastrocnemius flap in 2, medial myocutaneous gastrocnemius flap in 2, lateral gastrocnemius flap in 3, and combined medial and lateral gastrocnemius flaps in 2. All flaps completely survived without any flap-related complications. Fracture consolidation was established in all patients with an average period of 19.9 weeks (range 16-26). Surgical site infection occurred in 3 cases, and delayed union in 1. By functional score of Puno, 3 cases were determined to be excellent, 27 to be good, and 1 to be fair.
CONCLUSION
Concurrent use of internal fixation and gastrocnemius flap reconstruction is a reliable and efficient protocol in managing open fractures with accompanying soft tissue defect of proximal tibia.
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