Early internal fixation combined with free anterolateral thigh perforator flap transplantation to treat open ankle fracture-dislocation.
10.7507/1002-1892.202505079
- Author:
Xingfeng HU
1
;
Xiang WANG
1
;
Liang JI
1
;
Wei LIANG
1
;
Qixin LUO
1
;
Yang PENG
1
;
Qingsong LI
1
Author Information
1. Department of Hand and Microsurgery, the Fourth People's Hospital of Guiyang, Guiyang Guizhou, 550001, P. R. China.
- Publication Type:Journal Article
- Keywords:
Ankle fracture-dislocation;
anterolateral thigh perforator flap;
internal fixation;
soft tissue defect
- MeSH:
Humans;
Fracture Fixation, Internal/methods*;
Male;
Middle Aged;
Female;
Adult;
Retrospective Studies;
Perforator Flap/transplantation*;
Ankle Fractures/surgery*;
Thigh/surgery*;
Fractures, Open/surgery*;
Treatment Outcome;
Young Adult;
Plastic Surgery Procedures/methods*;
Fracture Dislocation/surgery*
- From:
Chinese Journal of Reparative and Reconstructive Surgery
2025;39(9):1175-1179
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE:To evaluate the effectiveness of early internal fixation combined with free anterolateral thigh perforator flap (ALTPF) transplantation in the treatment of open ankle fracture-dislocation.
METHODS:A retrospective analysis was performed on the clinical data of 13 patients with open ankle fracture-dislocation who were admitted and met the inclusion criteria between January 2021 and May 2024. Among them, there were 9 males and 4 females, with the ages ranging from 23 to 61 years (mean, 45.3 years). Fracture types included 5 cases of simple medial or lateral malleolar fracture-dislocation, 7 cases of bimalleolar (medial and lateral) fracture-dislocation, and 1 case of trimalleolar fracture-dislocation. Additionally, 3 cases were complicated with bone defects (1 medial malleolus defect and 2 lateral malleolus defects). All injuries were classified as type ⅢB according to the Gustilo-Anderson classification for open fractures. The size of wound defects ranged from 7 cm×5 cm to 18 cm×12 cm. The time from injury to surgery was 2-20 hours (mean, 4 hours). All patients underwent emergency thorough debridement upon admission. The fracture-dislocation was temporarily stabilized with an external fixator, and the wound was covered with antibiotic-impregnated bone cement sheets or vacuum sealing drainage. Definitive internal fixation of the fracture and free ALTPF transplantation were performed 5-7 days after the initial emergency procedure. Postoperatively, wound healing, flap survival, and fracture union were monitored. At last follow-up, clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.
RESULTS:All 13 patients were followed up 6-24 months (mean, 8.2 months). All flaps survived completely, and all fractures achieved union, with an union time of 3-11 months (mean, 5.5 months). One patient developed a superficial infection at the wound margin, which healed after regular dressing changes and drainage. No internal fixation-related complication (e.g., deep infection, implant loosening, or secondary ankle instability) were observed. At last follow-up, the total AOFAS ankle-hindfoot score was 78.6±13.5, with 3 excellent, 7 good, 2 fair, and 1 poor cases, yielding an excellent and good rate of 76.9%.
CONCLUSION:Early internal fixation combined with ALTPF transplantation for open ankle fracture-dislocation can shorten the treatment course and maximize the recovery of ankle joint function.
