Clinical efficacy of free flap in repairing Gustilo ⅢB and ⅢC fractures of tibia and fibula combined with soft tissue defects
10.3760/cma.j.issn.1001-8050.2018.10.005
- VernacularTitle:游离皮瓣修复Gustilo ⅢB、ⅢC型胫腓骨骨折伴软组织缺损的临床疗效
- Author:
Yongjun RUI
1
;
Yongwei WU
;
Jun LIU
;
Yunhong MA
;
Fengfeng LI
;
Yao LU
;
Tong YANG
;
Ming ZHOU
;
Yongqiang KANG
;
Jun GU
Author Information
1. 214062江苏省无锡市,无锡市第九人民医院,无锡市骨科医院创伤骨科
- Keywords:
Leg injuries;
Fractures,open;
Surgical flap
- From:
Chinese Journal of Trauma
2018;34(10):881-885
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the clinical efficacy of free flap transplantation in repairing the Gustilo type ⅢB and ⅢC fractures of tibia and fibula combined with soft tissue defects.Methods A retrospective case series study was conducted on the clinical data of 46 patients who had Gustilo type ⅢB and ⅢC fractures of tibia and fibula with soft tissue defects admitted from June 2013 to January 2017.There were 34 males and 12 females,aged 1-67 years (mean,39 years).The wound defect areas ranged from 6 cm × 20 cm to 7 cm × 38 cm.According to the Gustilo fracture classification,there were 31 cases of type ⅢB and 15 cases of type ⅢC.According to the AO fracture typing,there were five cases of type A,23 type B,and 18 type C.All patients were repaired with free flap transplantation,among which 40 patients were treated with anterolateral thigh flap and six with latissimus dorsi flap.The areas of anterolateral thigh flap ranged from 6 cm × 13 cm to 14 cm ×32 cm,and those of the latissimus dorsi flap from 6 cm × 22 cm to 7 cm × 40 cm.Efficacy was evaluated by flap survival rate,complications,fracture healing time,lower limb function scoring system (LEFS),and skin flap function.Results All limbs were salvaged successfully.One case of total flap necrosis and eight cases of postoperative crisis occurred.After active exploration and treatment,three cases were seen distal local necrosis,and the total survival rate was 91％.Infection at the donor site was found in two cases.The complication incidence rate was 4％.All patients were followed up for 7-42 months,with an average of 19 months.The fracture healing time averaged 43.5 weeks,and the LEFS score averaged 54 points.According to the seven indexes of flap function,the results were excellent in 1 1 cases,good in 29 cases,fair in four cases,and poor in two cases,with an excellent and good rate of 87％.Conclusion Free flap transplantation can achieve satisfactory efficacy in treating Gustilo type ⅢB and ⅢC of tibia and fibula combined with soft tissue defects,with high limb salvage rate and good function recovery.
