Objective: The aim of this study is to evaluate the feasibility of local flaps, Fasciocutaneous, Muscle & Musculocutaneous flaps, in the management of soft tissue defects with exposed fracture bone fragments in compound injuries of the lower extremity as a single-stage procedure (particularly the leg). To lay down clear and concise guidelines, merits and demerits of this technique for Orthopaedic surgeons in trauma wards.
Methods: In traumatised lower extremity having a soft tissue
defect & an exposed bone with or without associated fractures. Local flaps
provide a reliable single-stage procedure for coverage of lower extremity soft
tissue defects. The traumatised limb selected in which the wound was found to
be preferably in the upper 1/3rd, middle 1/3rd& uppermost part of the lower
1/3rd leg due to easy accessibility & placement of the local flap to these
areas. All flaps i.e. Fasciocutaneous, Musculocutaneous & local muscle
flaps were undertaken as a delayed procedure after careful evaluation of
traumatised limb by repeated dressings, debridement & control of infection.
Daily assessment of the wound for infection, and motor & sensory &
vascular status was made.
Definitive wound coverage was done by using a selected technique
in a routine operation at the same time a split-thickness skin graft was
applied on muscle pedicle flap or the defective area created by the
transposition of Fasciocutaneous, Musculocutaneous flap.
Fixation of bone was done before applying the technique.
Results: Stable wound coverage was achieved in all patients. The
excellent result was obtained in Muscle & Musculocutaneous flaps while the
good result was obtained in 10% of cases of Fasciocutaneous flaps. In a study
longest duration follow-up was 14 months & shortest was 3 months. 20 cases
of traumatised lower extremities (particularly the leg) which required local
flap coverage for soft tissue defects with exposed bone fragments.
Conclusion: Stable coverage can be achieved by flap techniques
using Fasciocutaneous, Muscle or Musculocutaneous flaps. Coverage of exposed
cortical bones, tendons & major vessels & adequate control of infection
can be achieved by Muscle & Musculocutaneous flap in post traumatised limb.
Fasciocutaneous flap (Ponten super flap) is very useful in the
repair of soft tissue defects as it is a much simpler, easy to design &
construct large flaps are safe due to good circulations, require less time
without any functional loss, post-operative management is simple for both
patient & staff.
Author (s) Details
Raghvendra Sadh
Department of PM&R, People’s College of Medical Sciences & Research
Centre, Bhopal (MP), India.
Vishnu Pal
Department of Human Anatomy, People’s College of Medical Sciences &
Research Centre, Bhopal (MP), India.
Please see the book here:- https://doi.org/10.9734/bpi/mmrnp/v11/1743
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