Flap Reconstruction for Severe Open Fractures and Dislocation of Lower Extremities.

概要

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Twenty open fractures or dislocations (19 patients) were treated using flap reconstruction. The persent study included 14 open tibial fractures (type II: n=3, type IIIA: n=1, type IIIB: n=10), 2 open femoral fractures (type IIIB: n=1, type IIIC: n=1), 2 open knee dislocations (IIIC), an open ankle dislocation (IIIB), and an open calcaneal dislocation associated with metatarsal fractures (IIIB). Flap reconstructive procedure were performed as follows, including the initial procedure and salvage procedures; free flap: n=5, local random pattern flap: n=9, local axial pattern flap: n=3, and pedicle muscle flap: n=9.Both the free flap and the local axial pattern flaps showed a 100% survival rate in all cases. On the other hand, the rates of distal necrosis in the local random pattern flaps and pedicle flaps were 33% and 63%, respectively. There were six deep infections in our study.In conclusion, we should carefully select the method of flap reconstruction for treating skin defects associated with severe fractures of the lower extremities in particular checking for unstable vascularity. It is also important, for protection from infection, to provide well-balanced soft-tissue management combined with bone fixation method.
西日本整形・災害外科学会の論文