Open tibial fractures with severe soft-tissue loss. Limb salvage compared with below-the-knee amputation.

Background: The prognosis in open fractures is primarily determined by the amount of soft tissue loss and the level of contamination. Severe open tibial fractures usually require combined orthoplastic approach in the management. Our aim is to study the effectiveness of soft tissue flaps in the management of type III B open tibial fractures.Methods: The study material consists of 20 cases of grade III B open tibial fractures admitted in our institution. Under anaesthesia, wound debridement was done and fracture stabilised with external fixator or IM nail depending upon the wound status. Patient underwent flap cover once the wound was fit. Periodic follow up was done.Results: Nonunion occurred in one patient (5%). Chronic osteomyelitis developed in two patients (10%). Deep infection occurred in three cases (15%). There was no secondary amputation in our series. The average union time of fracture was 30.1 weeks. Lower third fractures and those patients with extensive soft tissue injury, delayed flap cover and flap failure had longer union time.Conclusions: Fasciocutaneous flap has definitive role in the management of type III B open tibial fractures with soft tissue loss.

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External Pin Fixation with Early Flap Coverage for Open Tibial Fractures with Soft Tissue Loss

Journal of Medicine ◽

10.3329/jom.v11i1.4265 ◽

1970 ◽

Vol 11 (1) ◽

pp. 28-32

Author(s):

Md Shamsuzzaman ◽

Md Anowarul Islam ◽

Shah Mohammad Amanullah

Keyword(s):

Soft Tissue ◽

Tibial Fractures ◽

Tissue Loss ◽

Open Tibial Fractures ◽

Type Iii ◽

Pin Fixation ◽

Injury Treatment ◽

Radical Debridement ◽

Soft Tissue Loss ◽

Flap Cover

Meaningful data on the management of open tibial fractures cannot be obtained unless one categorizes the injury according to fracture type, degree of soft tissue loss and the velocity of the injury. Treatment by converting the type III injury to a type II injury with well vascularized soft tissue is presented. Eighteen patient with 20 type III and type III(a) wounds were treated in a prospective fashion employing a combined orthopedic and plastic surgical scheme based on the tenets of early radical debridement, a "second look" operation, muscle or fasciocataneus flap cover within the first 3 weeks for injury. All fractures united in a mean time of 6.0 months. The mean hospitalization was 6.2 weeks. There have been chronic infection, osteomyelitis nonunion, shortening or tissue breakdown. Keyword: Open tibial fractures, external pin fixation DOI:10.3329/jom.v11i1.4265 J Medicine 2010: 11: 28-32

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Three-stage limb salvage in tibial fracture related infection with composite bone and soft-tissue defect

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-04299-9 ◽

2021 ◽

Author(s):

Pablo S. Corona ◽

Carla Carbonell-Rosell ◽

Matías Vicente ◽

Jordi Serracanta ◽

Kevin Tetsworth ◽

...

Keyword(s):

Soft Tissue ◽

Limb Salvage ◽

Functional Outcomes ◽

Local Flap ◽

Tissue Loss ◽

Functional Score ◽

Limb Salvage Rate ◽

Soft Tissue Loss ◽

Infection Eradication ◽

Salvage Rate

Abstract Introduction Managing critical-sized tibial defects is one of the most complex challenges orthopedic surgeons face. This is even more problematic in the presence of infection and soft-tissue loss. The purpose of this study is to describe a comprehensive three-stage surgical protocol for the reconstruction of infected tibial injuries with combined bone defects and soft-tissue loss, and report the clinical outcomes. Materials and methods A retrospective study at a specialized limb reconstruction center identified all patients with infected tibial injuries with bone and soft-tissue loss from 2010 through 2018. Thirty-one patients were included. All cases were treated using a three-stage protocol: (1) infected limb damage control; (2) soft-tissue coverage with a vascularized or local flap; (3) definitive bone reconstruction using distraction osteogenesis principles with external fixation. Primary outcomes: limb salvage rate and infection eradication. Secondary outcomes: patient functional outcomes and satisfaction. Results Patients in this series of chronically infected tibias had been operated upon 3.4 times on average before starting our limb salvage protocol. The mean soft-tissue and bone defect sizes were 124 cm2 (6–600) and 5.4 cm (1–23), respectively. A free flap was performed in 67.7% (21/31) of the cases; bone transport was the selected bone-reconstructive option in 51.7% (15/31). Local flap failure rate was 30% (3/10), with 9.5% for free flaps (2/21). Limb salvage rate was 93.5% (29/31), with infection eradicated in all salvaged limbs. ASAMI bone score: 100% good/excellent. Mean VAS score was 1.0, and ASAMI functional score was good/excellent in 86% of cases. Return-to-work rate was 83%; 86% were “very satisfied” with the treatment outcome. Conclusion A three-stage surgical approach to treat chronically infected tibial injuries with combined bone and soft-tissue defects yields high rates of infection eradication and successful limb salvage, with favorable functional outcomes and patient satisfaction.

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Secondary reconstruction of below knee amputation stump with free anterolateral thigh flap

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1699417 ◽

2010 ◽

Vol 43 (01) ◽

pp. 108-110

Author(s):

Dinesh Kadam

Keyword(s):

Soft Tissue ◽

Vastus Lateralis ◽

Pressure Effects ◽

Tissue Loss ◽

Anterolateral Thigh Flap ◽

Vastus Lateralis Muscle ◽

Knee Amputation ◽

Amputation Stump ◽

Anterolateral Thigh ◽

Soft Tissue Loss

ABSTRACTBelow knee stump preservation reduces ambulatory energy expenditure and improves the quality of life. Reconstruction of soft tissue loss around the stump is a challenging task. Below knee stump reconstruction demands stable skin with sufficient soft tissue to allow weigh bearing. Microsurgical tissue transfer is increasingly being used as a salvage option. Anterolateral thigh flap with additional vastus lateralis muscle provides extra cushioning effect. We report two cases of amputation below knee successfully salvaged. The anterolteral flap with abundant tissue and stable skin offers a reliable option for cover. Two patients with below knee amputation were reconstructed secondarily. After 6 to 20 months of follow -up, stumps showed no signs of pressure effects. Patients are able to bear 50-70 hours of weight per week.

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