Recovery of Pretibial Skin Defects by Two Bipedicle Flaps

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Pretibial area has poor subcutaneous tissue, therefore, it is difficult to cover pretibial skin defects by STSG. Dr. Hartwell presented two bipedicle flaps in 1970 and Dr. Satomi reported a good result in 1972.We have been using this method since 1974 successfully.We had two cases each of pretibial open fracture, skin necrosis after open fracture and chronic suppurating osteomyelitis. We adopted the same design as Dr. Hartwell's.As Dr. Satomi reported, the advantages of this method are1. Less risk of flap necrosis, 2. Less pain to the patient because it does not require the cross-leg position, 3. Shorter treatment period.Besides it does not require a special skill as free flap.We present two typical cases as follows:I. The first is pretibial chronic suppurating osteomyelitis. We took out the scar including the fistula in 3×12cm, scraped marrow, cleaned it and transplanted a piece of iliac bone to the dead space, then closed it by two bipedicle flaps. We noticed the redness in the suture but it cured completely.2. The second is fresh pretibial open fracture. The skin was perforated by a piece of bone approximately 4cm wide. We fixed inside with 12cm KU plate, incised out the crushed skin, then closed it by two bipedicle flaps. Both bone fusion and suture were excellent.
西日本整形・災害外科学会の論文