Emergency primary reconstruction of bone and soft tissue defects in Gustilo Ⅲ C fracture of both legs: a case report
10.3760/cma.j.cn441206-20250220-00036
- VernacularTitle:双侧小腿Gustilo Ⅲ C型骨折急诊一期修复骨和软组织缺损1例
- Author:
Zhong ZHANG
1
;
Xiaoju ZHENG
1
;
Xinhong WANG
1
;
Qian LIN
1
Author Information
1. 西安凤城医院手足显微外科病院,西安 710016
- Publication Type:Journal Article
- Keywords:
Chimeric flap transfer;
Gustilo Ⅲ C injury;
Bone defect;
Leg;
Vascular anastomosis
- From:
Chinese Journal of Microsurgery
2025;48(4):460-465
- CountryChina
- Language:Chinese
-
Abstract:
This is a case report of bilateral Gustilo ⅢC fracture with tibial defects in both legs and combined with defects of soft tissue. The injury was treated by emergency surgery in November 2021 in the Hand and Foot Microsurgery Hospital, Xi'an Fengcheng Hospital. It was found that annular avulsion injury with partial defect of soft tissue in left leg from under the knee to ankle (10.0 cm × 4.0 cm, 14.0 cm × 8.0 cm), distal tibia-fibula fractures and partial bone defect of tibia (6.0 cm), anterior tibial artery and posterior tibial artery rupture, and posterior tibial nerve and foot were both intact. Of the right leg, it was found that there was an annular avulsion injury with partial defect of soft tissue between 1/3 of proximal leg and above ankle (25.0 cm × 10.0 cm), distal tibia-fibula fractures and partial tibial defect (4.0 cm), anterior tibial artery was ruptured and the posterior tibial artery was embolised, but posterior tibial nerve and foot were both intact. There was no blood supply in both feet. A chimeric fibular flap of right peroneal artery (15.0 cm × 6.0 cm, and the excised fibula was 13.0 cm long) was harvested and further divided into 2 chimeric flaps for reconstruction of the defects of bilateral tibia and soft tissue. A chimeric flap pedicled with descending branch of left lateral circumflex femoral artery (29.0 cm × 8.0 cm) was harvested and further divided into 2 chimeric tissue flaps pedicled with the descending branch of lateral circumflex femoral artery to cover the remaining wounds of both calves. The proximal peroneal artery was anastomosed with anterior tibial artery, and the distal peroneal artery was anastomosed with the lateral circumflex femoral artery carried by chimeric flap, and bilateral posterior tibial arteries were bridge anastomosed with the great saphenous veins. All patients were entered in the scheduled follow-up at 4, 8 and 12 weeks after surgery. The walking and the movement of ankles and toes were gradually recovered. At 1 year after surgery, the patient was able to get of the bed by himself. Plantar sensation regained to S 4 and there was a slight limb in walking, but without pain, wear or ulceration in feet.
