Concurrent internal fixation and soft tissue reconstruction by distally based sural flap: a practicable scheme for complex distal tibial fractures

2020 ◽  
Author(s):  
Surasak Jitprapaikulsarn ◽  
Kritsada Sukha ◽  
Chawanan Patamamongkonchai ◽  
Arthit Gromprasit ◽  
Witoon Thremthakanpon
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
Tibial Fractures ◽  
Soft Tissue Reconstruction ◽  
Sural Flap ◽  
Distal Tibial Fractures ◽  
Tissue Reconstruction ◽  
Distally Based ◽  
Distally Based Sural Flap

scholarly journals Distally Based Sural Faciocutaneous and Fascial (Adipofascial) Flap for Reconstruction of Distal Leg, Ankle and Foot Defects

2015 ◽  
Vol 12 (2) ◽  
pp. 126-131 ◽  
Author(s):  
NP Parajuli ◽  
D Shrestha ◽  
N Panse
Keyword(s):  
Soft Tissue ◽  
Secondary Infection ◽  
Soft Tissue Defect ◽  
Soft Tissue Reconstruction ◽  
Sural Flap ◽  
Hind Foot ◽  
Sural Artery ◽  
Distally Based ◽  
Distally Based Sural Flap ◽  
Ankle And Foot

Background Any soft tissue defect in distal leg, ankle and hind foot is still a challenging problem. There are various options for coverage of such defects, but the distally based sural neurocutaneous and neurofascial flap based on the sural nerve and superficial sural artery has been an important option.Objective To evaluate the efficacy of distally based sural flap in reconstruction of the distal leg, ankle and hind foot soft tissue defects.Method Seventeen patients with soft tissue defects over distal leg, ankle and hind foot were included in this study. All patients were treated with distally based sural flap. Most of the cases were due to trauma (16 cases) which compromised tendon and bone. One case was of malignant melanoma of sole of hind foot which required wide excision and soft tissue reconstruction with sural flap.Result In all cases defects were successfully covered. Three showed venous congestion and partial necrosis. One developed secondary infection. One flap failed completely. Mean follow up of patients was 20 months (6 – 36 months).Conclusion Sural flap is a good option for reconstruction of distal leg, ankle and foot defects.Kathmandu University Medical Journal Vol.12(2) 2014: 126-131

Timing of Soft Tissue Reconstruction

2020 ◽  
pp. 57-62
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
Free Flap ◽  
Soft Tissue Reconstruction ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Fracture Union ◽  
Patient Factors ◽  
Tissue Reconstruction ◽  
Wound Excision

Soft tissue cover of a meticulously and comprehensively excised (debrided) wound is the cornerstone of achieving infection-free fracture union. Planning of the soft tissue reconstruction should ideally occur at the time of wound excision. Definitive soft tissue reconstruction should be performed within 72 hours of the injury unless precluded by patient factors, and at the same time as internal fixation of the fracture. Free flap reconstruction is ideally performed on scheduled lists in specialist orthoplastic centres.

Temporary Wound Dressings

2020 ◽  
pp. 31-40
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
Normal Saline ◽  
Negative Pressure ◽  
First Aid ◽  
Wound Dressings ◽  
Soft Tissue Reconstruction ◽  
Wound Therapy ◽  
Tissue Reconstruction ◽  
Wound Excision

Temporary dressings are used to cover the wound from the time of first aid through to definitive soft tissue closure. Frequent dressing changes should be avoided to reduce contamination by nosocomial organisms. Therefore, the initial dressing should be simple to apply and maintain tissue viability by preventing desiccation, e.g. gauze soaked in normal saline and covered with an occlusive film as per the National Institute for Health and Care Excellence guidance. Following wound excision, a simple non-adherent dressing can be used. Negative pressure wound therapy should not be used to downgrade the requirement for definitive soft tissue reconstruction, which should be achieved within 72 hours of injury. Following internal fixation, definitive soft tissue reconstruction should be performed at the same time.

Ankle spanning external fixator with limited internal fixation for distal tibial extra-articular fractures

2017 ◽  
Vol 5 (10) ◽  
pp. 4355
Author(s):  
Siddharth Goel ◽  
Abhay Elhence
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
External Fixation ◽  
External Fixator ◽  
Tibial Fractures ◽  
Fixation Method ◽  
Ankle Pain ◽  
Distal Tibial Fractures ◽  
Tract Infections

Background: Fractures of the distal tibia are among the most difficult fractures to treat. The short distal segment presents difficulty in choosing the appropriate fixation method. The greatest challenge lies in the relatively tight soft tissue around the ankle. As a result, it has been a recent interest in treating these fractures with external fixation and limited internal fixation. The external stable fixation methods used are tubular or ring fixators, with or without immobilising the ankle. This minimally invasive nature of the surgery can avoid catastrophic wound complications like dehiscence, implant exposure and infection.Methods: 18 patients with extra-articular distal tibial fractures (AO Type 43A) were treated with the technique of ankle spanning external fixation. Lag screws or K-wires were supplemented for limited internal fixation when required. Fibula was stabilised in all cases. Intra- articular and Compound fractures were excluded. In addition to union at fracture site, ankle pain and motion was noted in each follow-up.Results: The mean follow-up was 25 months. Of the 18 patients included all but one fractures united with an average healing time of 16 to 18 weeks. Ankle pain and motion was graded according to Mazur modified by Teeny and Wiss clinical scoring system. 15 of them had excellent or good results, 2 had fair results. One patient had poor result. Five pin tract infections occurred. 17 patients had no evidence of osteoarthritis after completing follow up of at least 2 years.Conclusions: Distal tibial fractures are complex injuries, not only regarding the bony component, but also in terms of the management of the soft tissue problem. Ankle Spanning External Fixator with Limited Internal fixation is a relatively simple and cost-effective method for treating these fractures, achieving union and also maintaining ankle function.

Distally Based Anteromedial Thigh Fasciocutaneous Island Flap for Patellar Soft Tissue Reconstruction

2009 ◽  
Vol 66 (4) ◽  
pp. 1146-1151 ◽  
Author(s):  
Lin-Shing Chou ◽  
Ke-Chung Chang ◽  
Tuso-Wu Lin ◽  
Hui-Chiou Chou
Keyword(s):  
Soft Tissue ◽  
Island Flap ◽  
Soft Tissue Reconstruction ◽  
Tissue Reconstruction ◽  
Distally Based
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