Abstract

CAMPORRO-FERNANDEZ, D.; ONTANEDA-RUBIO, A.  and  CASTELLANOS-MORAN, M.. Gustilo IIIB-IIIC open tibial fractures requiring microvascular free flaps. Cir. plást. iberolatinoam. [online]. 2015, vol.41, n.3, pp.283-293. ISSN 1989-2055.  https://dx.doi.org/10.4321/S0376-78922015000300008.

The purpose of this article is to report our clinical experience of lower extremity microsurgical reconstruction in severe Gustilo IIIB or IIIC open tibial fractures, and to describe our treatment protocol for these patients. Fifty-one free flaps were used in 49 consecutive patients. Debridement and stabilization of the fracture were invariably performed in the first day of the injury. The number of debridements prior to definitive treatment was between 1-3 (mean 2,1). Severe soft-tissue defects requiring flap coverage were treated 6-19 days (mean 9,3 days). Survival was achieved in 46 flaps (90,2%); the 5 free flaps failed were solved 2 with limb amputation, one with a secondary free flap, and 2 with cross-leg flaps. Twenty-three (47%) fractures progressed to primary bony union while 26 (53%) required a bone-stimulating procedure to achieve this outcome. Overall, there was a rate of deep infection at the site of fracture of 4%, and of serious infected bony nonunion of 4%. One extremity underwent secondary amputation. The salvage rate of functional limb was 94%. Severe open tibial fractures should be referred directly to specialist centres for simultaneous combined management by orthopaedic and plastic surgeons. Although the various specialties involved in the management of severe limb injuries have significantly improved over the past few decades, successful free-flap reconstruction is key to ensuring an infection-free fracture union.

Keywords : Open tibial fractures; Lower limb reconstruction; Free flaps.

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